LIBRARY OF CONGRESS. 



%p i## !fa 

UNITED STATES OF AMERICA. 

; *- 



THE PRESENT 



TREATMENT OF DISEASE. 



AN 



OUTLINE OF THE MEDICAL PRACTICE 
OF THE DAY. 



BASED UPON RECENT CLINICAL CASES. 



BY 



RICHARD J. DUNGLISON, A.M., M.D., 

AUTHOR OF "A HANDBOOK OF DTAGNOST8, THERAPEUTICS, PRESCRIPTIONS AND DIETETICS;" 
SECRETARY OF THE AMERICAN ACADEMY OF MEDICINE, ETC., ETC. 






"J^ft- V ? 



PHILADELPHIA: 
PRESS OF WM. F. FELL & CO., 

1220-24 Sansom Street. 
1886. 



-*£** 

-$>°> 



Copyright, 1886, 

BY RICHARD J. DUNGLISON, M.D. 

All Rights Reserved. 



PREFACE. 



The views of treatment, the applications and uses 
of new remedies, and the original prescriptions 
contained in this work, have been very recently 
reported from actual clinical cases, and in many 
instances phonographically, directly from the teach- 
ings of the medical gentlemen quoted. These thera- 
peutic notes illustrate more than two hundred of 
the important affections which come within the 
every-day observation and experience of the phy- 
sician, and the treatment cited will serve as a 
truly reliable and useful guide to the practitioner. 
They have been chiefly compiled from the pages of 
the College and Clinical Recokd. 

EICHARD J. DUNGLISON. 



814 N. Sixteenth Street, 
Philadelphia. 



THE PRESENT 

TREATMENT OF DISEASE. 



ALBUMINURIA. See Bright's Disease. 



ALCOHOLISM. 

To counteract the craving for alcoholic stimulants, 
when they are withdrawn, and to sustain the nervous 
system, the following combination is effective (Bar- 
tholow) : — 

Tinct. capsici, £5vj 

Tinct. nucis vomicae, f5ij. M. 

Sig. — Twenty drops, in water, every four hours. 



Prof. Da Costa directed, in a case of alcoholic hal- 
lucinations, that all liquor be immediately stopped ; 
that he take extract, erythroxylon (coca) fluid., gtt.xv 
ter die, to be raised to the point of tolerance; at 
night, sodii bromidum, gr.xv, and chloral, gr.x, in 
syrup and water, every hour, till quiet, but not more 
than four doses to be taken in one night. In these 
cases feeding is of great importance ; he should take 

9 



10 THE PRESENT TREATMENT OF DISEASE. 

some nourishing, easily digested food every two hours, 
as milk, broth, oysters, eggs, and also just before 
going to bed. 

Prof. J. K. Bauduy, of St. Louis, in a paper on 
cocaine, states that it has been well known for some 
time that the fluid extract of coca was a valuable 
remedy in the treatment of alcoholism and the opium 
habit, but it is not to be compared with the alkaloid 
cocaine in this regard. It not only replaces alcohol 
and morphine, but it generates a positive disgust for 
these agents. They can be withdrawn completely 
and at once without the slightest suffering or injury, 
and the cocaine itself may be gradually dispensed 
with, thus eventuating in perfect recovery. The 
only caution to be observed in these cases is to ad- 
minister the drug hypodermically, and this by the 
hand of the physician himself. The drug should 
not be known to the patient, nor the amount of the 
alkaloid which is given. If these precautions are not 
adopted there is great danger — nay, a certainty — 
that a cocaine habit will be formed, more disastrous 
in its results than alcoholism or morphinism. 



ALOPECIA. 

Prof. Bartholow considers pilocarpus the most 
efficient remedy we possess for alopecia. For local 



AMENORRHEA. 11 

application he combines with equal parts of soap 
liniment, the fluid extract; or one part of fluid 
extract of pilocarpus, one of tincture of cantharides, 
and two of soap liniment. 



For alopecia, Prof. Gross, among other things, 

advises that the hair be shingled, then the head 
cleansed with — 

Saponis viridis, §ij 

Aquae Cologniensis, f§iv. M. 
Sig. — As a wash every third night. 

Then use several times daily — 

Tinct. cantharid., fSiss 

Tinct capsici, gtt.xx 

Glycerini, f5ss 

Aquae Cologn., q.s. ad f5j. M. 



AMENORRHEA. 

For amenorrhoea dependent upon debility, Prof. 
Parvin advises the following, speaking highly of its 
utility :— 

Ferri sulphat. exsiccat., gr.j 

Aloes, gr.j 

Olei terebinthinse, gtt.j. M. 

Ft. pil. 
Sig. — One ter die. 



12 THE PRESENT TREATMENT OF DISEASE. 

In another clinical case, he recommended per- 
manganate of potassium for amenorrhoea from cold 
feet, etc., in doses of gr. j ter die, increased at the 
end of a week to gr. ij four times a day if necessary. 
In pills it is liable to spontaneously explode ; it may 
be given in capsules mixed with powdered elm or 
licorice. Its effect should be seen in three or four 
days. He thinks it the best emmenagogue, apiol 
being second best. Of this, three drops, on a little 
sugar, are given a few days before the time at which 
the menses are expected. Prof. Bartholow thinks 
the permanganate the most efficient emmenagogue of 
the materia medica. 

In cases of amenorrhoea due to torpid action of the 
ovaries, Prof. Goodell* ordered the following pre- 
scription : — 

Extract, aloes, 5j 

Ferri sulph. exsic, 5\j 

Asafoet, 5iv. M. 

Fiant pil. c. 
SiG. — One pill to be taken after each meal. This num- 
ber to be gradually increased, first to two and then to 
three pills after each meal. 

If the bowels are at any time over-affected, the 
patient is to stop and begin again with one pill. 

* Medical Record. 



AMENOEJRHCEA. 13 

Where the amenorrhoea is due to arrested develop- 
ment, Dr. Goodell has derived the very best results 
from the constant use of Blaud's pill, as recom- 
mended by Niemeyer : — 

9. 

Pulv. ferri sulph., 

Potas. carb. purse, aH 5ij 

Mucil. tragacanth., q.s. M. 

Fiant pil. xlviii. 
Sig. — To be given daily, in increasing doses, until three 

pills are taken after each meal. 

This gives the large quantity of twenty-two and a 
half grains of the dried sulphate of iron per diem. 

If these pills give rise to constipation, Dr. Goodell 
uses this formula (compound licorice powder) : — 

]*. 

Pulv. glycyrrhiz. rad., 
Pulv. sennse, aa §ss 

Sulphur, sublira., 

Pulv. foeniculi, aa 5ij 

Sacchar. purif., Siss. M. 

Sig. — One teaspoonful in half a cupful of water at 
bedtime. 

Where the suppression is due to change of habits 
and loss of health, tonics are employed. When the 
suppression comes on suddenly, from cold or ex- 
posure while in the midst of the menses, and is 
accompanied by severe lumbar pains, the patient is 



14 THE PRESENT TREATMENT OF DISEASE. 

placed in a mustard hip-bath, a Dover's powder is 
administered, she is put to bed and hot drinks are 
given to provoke copious diuresis and diaphoresis. 



In another case of amenorrhoea, Prof. Parvin 
prescribed rest alone, but cautioned the class not, 
from this single example, to conclude that all cases 
of the disorder are to be similarly treated. Some of 
them may require apiol, others iron, or aloes and 
iron ; still others the permanganate of potassium ; 
others, again, the cantharidal tincture, or local de- 
pletion, and thus on, through divers and diverse 
therapeutic means. 



AN/EMIA. 

Prof. Da Costa is partial to Blaud's pill in ansemia 
with attending disorders of menstruation. It is best 
made up with glucose, to prevent chemical decom- 
position, as follows : — 

Ferri sulph. desiccat., 

Potass, carbonat., aa 5j 

Glucose, q.s. M. 

Ft. pil. xl. 
Sig. — One pill after each meal ; to be increased to 

three. 

Suspend the treatment during menstruation. 



ANEMIA. 15 

In the case of an anaemic girl with functional dis- 
turbance of the heart, due to dyspepsia, he prescribed 
a meat diet, plenty of exercise, and — 

Tinct. gentian, ferrat., f3j 

Tinct. nucis vomicae, gtt.v. M. 

Sig. — Ter die. 

He speaks highly, also, of a double salt of sodium 
and iron, the pyrophosphate, in the treatment of 
anaemia. As it is unirritating, it is the best salt for 
hypodermic use. It is freely soluble, and can be 
given in large doses, as it does not irritate the 
stomach, nor does it produce constipation. 



For a case of simple anaemia, which had resisted 
the ordinary treatment of iron, exercise and food, he 
prescribed — 

Liq. potass, arsenit., f5j 

Massae ferri carb., 5ij 

Syrup, simplic, q.s. ad foiv. M. 

Sig. — 5j, after each meal, and take, before each meal, 
tinct. nuc. vomicae, gtt. x. 

Exercise in open air about three hours after eating. 
An occasional purge in the form of the official pill 
of aloes and ferrum ; or if there be flatulency, of aloes 
and asafcetida. 



16 THE PRESENT TREATMENT OF DISEASE. 

A young woman — a seamstress — was prescribed 
for by Prof. Bartholow, suffering from severe anaemia 
and headache. He said it was not wise to give the 
bromides in such a case, but better the phosphate of 
iron, quinine and strychnine, with well-regulated 
outdoor exercise. Diet — meats, and not too much 
of starchy matters. Inunctions of fat at night, after 
a warm bath, are of value. 



AN/EMIA, PERNICIOUS. 

Prof. Da Costa, in his experience with idiopathic 
pernicious anaemia, thinks the books give the dura- 
tion of this disease as too short ; it is several years, 
as a rule, though it may run a more rapid course in 
pregnant women. His belief in the fatality of the 
prognosis is very strong, and he doubts the diagnosis 
in all the reported cures he has read of ; but is much 
more hopeful than formerly concerning the proba- 
bility of prolonging life. The greatest possible 
attention must be paid to obtaining a blood-making 
diet. Freshly-drawn bullock's blood is advantageous, 
where it is not too offensive to the patient. A sea 
voyage is of great benefit. Manganese is useless ; 
iron in very large doses, of some value ; and arsenic 
in small doses, long continued, has given him better 
results than any other remedy. In the later stage, 



ANEURISM. 17 

when transfusion is bruited, he discourages it, for 
improvement from it is only very temporary. 



ANEURISM. 

In an interesting clinical case,* Prof. Da Costa 
exhibited the great value of iodide of potassium in 
the cure of internal aneurism. The woman had had 
fifteen grains thrice daily, which was a very full 
dosage for her, because every now and then frontal 
headache and coryza demonstrated that she possessed 
an unusual susceptibility to the drug, and its use 
must then be intermitted. She had been on this 
treatment for some time, and had had nothing else, 
save a little morphine when the pain was very 
severe, and iodide of cadmium ointment to the en- 
larged glands. She had had no particular diet, and 
nothing special had been done for an accompanying 
cough or dyspnoea, save a little morphine and atro- 
pine at first, when the cough was very severe and 
irritating. It is seldom that one sees a cure where 
the benefit to be derived from the iodide of potassium 
is so very marked. Dr. Da Costa thinks that treat- 
ment by full doses of iodide of potassium and a 
moderate diet, rather under than overfeeding the 
patient, and absolute rest in bed, is the best that 

* Therapeutic Gazette. 



18 THE PRESENT TREATMENT OF DISEASE. 

can be adopted. This latter injunction is very im- 
portant. In addition, he keeps the action of the 
heart subdued by aconite; for pain, ice over the 
tumor, and rub with an ointment of aconitia, gr.j, to 
vaseline, oj. A quiet life, rest in bed and a dry diet, 
are enjoined upon the patient. 



ANGINA PECTORIS. 

In a clinical case of this disease, simulating asthma, 
Prof. Da Costa said the indications for treatment are 
to relieve the pain during the attacks of angina, and, 
secondly, to act upon the diseased organ, to relieve 
its condition, as far as possible, by remedies im- 
proving nutrition. For the condition of angina 
itself, during the attack, nothing will give more 
relief than nitrite of amyl. It is used in capsules 
containing from three to five minims each. These 
are to be crushed in a handkerchief and the vapor 
inhaled. It is astonishing how rapidly it acts, as the 
rule. If it does not relieve him sufficiently, he shall 
also have a quarter of a grain of morphia hypoder- 
mically, at once. 

After the urgent symptoms have been relieved, 
the condition of the heart also requires to be 
studied out. What remedy will act upon the heart 
itself and restore a healthy condition ? Arsenic is 



APHTHOUS SOEE MOUTH. 19 

often a useful remedy in such cases, but the arsenic 
must be pushed to obtain its full physiological effect 
before you can be sure whether it will succeed or fail. 
Digitalis is often a valuable remedy, but its effect 
upon the heart is less permanent. Strychnia is also 
a good agent. Cannabis indica is very good. He 
could see no reason why they should not be combined 
in this case : — 

Acidi arseniosi, gr.-gV 

Ext. cannabis indica?, g r «yV M. 

Ft. pil. 
Sig. — To be taken three times a day, after eating. 

The bowels must not be allowed to be constipated, 
so that there shall be no straining. He shall have 
a regulated diet, nourishing, rather concentrated; 
avoiding bulky food, and indigestible articles, 
such as pies or pastry. As the patient also com- 
plained of indigestion and want of appetite, he was 
ordered tincture of nux vomica, ten drops three 
times a day. 

APHTHOUS SORE MOUTH. 

Prof. Ellerslie Wallace believed that the sodium 
sulphite solution was the best remedy for aphthous 
sore mouth in infants : — 



20 THE PKESENT TREATMENT OF DISEASE. 

Sodii sulphit., gr.xxx 

Glycerini, 

Aquae, aa fgss. M. 

Sig. — To be used on a swab every two hours. 

Where the child is using a nursing bottle, scrupu- 
lous cleanliness is required. The rubber nipple 
should be turned inside out after each time of using, 
washed clean, and placed in a solution of bicarbonate 
of sodium (baking soda), in a tumbler, until again 
needed. It is better to have two, and use them 
alternately. Milk must never be allowed to stand 
in the nursing bottle until it becomes sour. 



APOPLEXY. See Paralysis. 



ARGYRIA. 

A patient presented himself at Prof. Bartholow's 
clinic, who, having contracted syphilis many years 
ago, had suffered from ulcerative sore throat. To his 
throat he had for two years applied nitrate of silver, 
until by this time he suffered from all the symptoms 
of argyria. He was placed upon — 

fy. 

Sodii hypophosphit., gr. v-x. 

Sig. — Ter die. 



ASTHENIA. 21 



Locally a solution of cyanide of potassium was 
directed to be applied ; both remedies to be persist- 
ently used. 



ARTERITIS. See Endarteritis. 



ASTHENIA. 

For tremor due to asthenia from exhausted nervous 
system, Prof. Da Costa directed to be taken — 

3, 



M. 



Acid, phosphoric, dil., 
1 Strychninae phosphat., 
Elixir, sitnpl., 
Aquae, aa 
Sig. — Ter die, in water. 


gtt.xx 
f3ss. 



As a tonic in the asthenic type of fevers, Prof. 
Gross advised the following : — 

1*. 

Quininse sulphat., gr.ij 

Tinct. ferri chloridi, 

Acid, hydrochlor. dilut., aa gtt.xv 
Tinct. nucis vomicae, gtt.x 

Syr. zingiberis, f5ij. M. 

Sig. — This amount ter die. 

Instead of the nux vomica fa grain of strychninae 
sulphas may be employed. 



22 THE PRESENT TREATMENT OF DISEASE. 

Prof. Gross says an excellent tonic in asthenia is — 
3, 



M. 



ASTHMA. 

Prof. Bartholow has succeeded in affording great 
relief to sufferers from this distressing complaint by 
the administration of fifteen grains of the iodide of 
potassium and twenty grains of the bromide of potas- 
sium four times a day. This combination has been 
found to be particularly useful where there was any 
spasm of the bronchi. 



Quininse sulph., 






Ferri sulph., 


aa 


g r -\j 


Strychnine sulph., 




gr.?V 


Capsici pulv., 




g r -i- 


Sig. — One ter die. 







Dr. J. S. Neff, at the Jefferson Medical College 
Hospital, has used, with perfect success, the new drug 
pyridine in the treatment of the paroxysms of 
asthma in several cases, independently of the cause, 
whether bronchial, cardiac or renal. It seemed not 
only to relieve the paroxysm, but also to prevent the 
return, in a measure. As the remedy is so very irri- 
tating to all the mucous membranes, the following 
method is used in its administration. The patient 
being placed in a small room, from thirty to forty 



ASTHMA. 23 

drops of the drug are put on a plate and placed at a 
little distance from the patient. This may be re- 
peated if necessary, and the inhalations kept up from 
five to thirty minutes, but relief is usually obtained 
in from one to five minutes. 



At Prof. Da Costa's clinic, a boy, set. four years, 
who had had pure nervous asthma since he was one 
year old, was given — 

Sodii broraidi, g r -"j 

Tinct. belladonnse, gtt.j 

Syrup tolutan., 

Aquae, aa f5ss. M. 

Sig. — Ter die, well diluted. 



The following combination of Prof. Bartholow's, 
for asthmatic attacks, has been found very useful : — 

Ext. grindelise fluid., f5ss 

Ext. lobelise fluid., f5ij 

Ext. belladon. fluid., f5j 
Potassii iodidi, 5iij 

Glyceriui, fSiij. M. 

Sig. — Tablespoonful as required. 

He considers iodide of ethyl a very valuable anti- 
spasmodic, singularly and immediately beneficial in 
spasmodic asthma, also lessening the liability to sub- 



24 THE PRESENT TREATMENT OF DISEASE. 

sequent attacks. In capillary bronchitis it is con- 
spicuously beneficial, as also in catarrhal pneumonia. 
In chronic bronchitis it is a most valuable agent, from 
its local action. It will probably take the place of 
iodine vapor for respiratory diseases. The dose is 
gtt. v-xx three or four times a day, by inhalation, 
generally from a handkerchief. 



In humid asthma, Prof. Bartholow speaks very 
confidently of the following combination : — 



Tinct. sanguinarise 


y 




Tinct. lobelise, 


aa 


f3j 


Ammonii iodidi, 




5j 


Syr. tolutan., 


ad 


fSj. 


Sig. — f5j every two or 


three hours. 





M. 



Prof. Da Costa prescribed, in a clinical case, the 
centesimal solution of nitro-glycerine for asthma, 
commencing with one drop ter die. 



ATHEROMA. 

In a case of general atheroma of the blood vessels 
with marked trembling, associated also with aortic 
regurgitation and narrowing, in a man aged sixty- 
three, Prof. Da Costa directed hyoscyamine, gr. m 



BOTJLIMIA. 25 

each night, to be increased to gr. T fa if necessary, for 
the trembling. For the atheroma : — 

Acid, phosphoric, dil., gtt.xx 

Tinct. cinchonse comp., gtt.xl. M. 

SiG. — Ter die. 



BLADDER, AFFECTIONS OF. See Genito-Urinary Organs. 



BOULIMIA. 

At Prof. Da Costa's clinic, a patient set. twenty- 
four presented himself, complaining of inordinate 
appetite — boulimia ; he was always hungry ; had 
been so troubled for eight years, during which time 
he had gone from one institution to another and from 
one doctor to another, seeking relief but finding none. 
The trouble came on gradually, without cause; no 
evidence of tapeworm was ever found ; no excessive 
thirst. He ate five or six meals each day ; for break- 
fast he took 1 lb of beef, i lb of bread, potatoes and 
tea ; the remaining meals were equally large. He 
slept well ; his heart beat rapidly ; his spleen and 
liver were normal in size. As far as known this 
affection is due to deranged nervous action. 

The fluoride of calcium deprives one of appetite 
and of strength, and that would be prescribed as a 
last resort. He was ordered fifteen grains of the 



26 THE PRESENT TREATMENT OF DISEASE. 

bromide of sodium, in mint water, ter die. The 
patient returned cured ; he now eats three meals a 
day and is satisfied; he no longer feels weak and 
hungry between meals, and is gaining in weight. 
He was directed to take the bromide only twice a 
day, and in addition gtt.xv of the fluid extract of 
coca, ter die. 

BRIGHT'S DISEASE. 

In a case of chronic Bright's disease presented at 
the clinic, Prof. Bartholow observed : — 

These cases are readily diagnosticated, but the 
difficulty is in the treatment. We now have at our 
command some remedies which exert a remarkable 
effect upon this malady. The first of these is nitro- 
glycerine. Its introduction has given quite a different 
complexion to the treatment of these cases. It is 
employed in the form of the centesimal solution : one 
minim of nitro-glycerine dissolved in one hundred 
minims of alcohol. One minim of this one per cent, 
solution is the beginning dose. This may appear an 
extremely minute dose, but in some persons the action 
of the heart is accelerated and the face flushed by a 
single minim, while others may take fixe to fifty 
minims. He had, a short time ago, a patient who 
could take eighty minims of this solution, not only 



bright's disease. 27 

without injury, but with decided benefit. This was 
a case of spasmodic difficulty of breathing. In 
albuminuria he had found that the dose readily 
borne by an adult is from one to five drops, the 
average probably being three drops. Begin with 
the smallest dose, and gradually increase until the 
characteristic symptoms are produced. It is neces- 
sary to produce these characteristic physiological 
effects in order to obtain the best results. It is for- 
tunate that these effects can be obtained without any 
injury to the patient, provided the remedy is used 
in anything like the proper dose. It is perfectly 
safe within these limits. 

We give nitro-glycerine for the effect which it has 
on the circulation and its secondary effect upon the 
structure of the kidney. It produces marked dilata- 
tion of the peripheral vessels. This at once takes 
away the blood from the important large vessels and 
central organs, and distributes it to the periphery. 
Of course, when the arteries are suddenly dilated, 
the work to be done by the heart is reduced, and it 
can send the blood on the round of the circulation 
with less force. Nitro-glycerine in this way relieves 
the heart and lowers the high tension which belongs 
to this malady. Secondarily, it opens the way to 
the relief of a condition that had hitherto not been 



28 THE PRESENT TREATMENT OF DISEASE. 

relieved by any measure which we had under our 
command. 

It has been demonstrated, too, that the amount 
of albumen progressively diminishes under its use. 
The extent of improvement depends upon the 
amount of damage which the kidneys have suf- 
fered. We cannot restore lost parts. We cannot 
put new structure into the kidney, any more than 
we can restore a finger that has been amputated. 
If we wish to accomplish good, we must begin 
early. There is no time to be lost. We will 
begin with the administration of minim doses of 
the centesimal solution of nitro-glycerine, four 
times a day, and gradually increase the dose until 
the patient feels the characteristic flushing of the 
face and the other symptoms produced by this 
remedy. 

Have we any other remedy? We have a drug 
which is potent in preventing hypertrophy of the 
connective tissue of the kidney, chloride of gold and 
sodium, which has been followed by remarkably good 
results in these cases. The dose is one-twentieth of 
a grain three times a day. 

In addition to this, the bowels should be kept in 
good condition by the use of a weak saline water, 
the function of the skin is to be kept active by the 



bbight's disease. 29 

use of warm clothing, and the patient should care- 
fully guard against changes of temperature. 

There is another remedy which is also a food ; that 
is skim-milk. The patient should live largely upon 
this, which acts as a diuretic as well as food. As a 
rule, he should avoid solid food, living almost exclu- 
sively on a liquid diet. As he improves, the amount 
of solid food may be increased. These hygienic 
measures are of the greatest importance, for without 
them it is hopeless to expect a favorable result from 
any method of treatment. 

He wished it to be remembered that in many cases 
there is a syphilitic history, in at least ten per cent., 
and in such cases, with the remedies already indi- 
cated, he would combine the corrosive chloride of 
mercury in doses of one-fortieth of a grain. 



In a case illustrating the form of Bright's dis- 
ease called parenchymatous nephritis, contracted 
kidney, Prof. Da Costa, at the Pennsylvania Hos- 
pital, said : — 

What does the most good in these cases is vigorous 
counter-irritation by the use of turpentine and dry 
cupping all over the chest, and the internal adminis- 
tration of ammonia. Whether we use the aromatic 
spirits, half a drachm every half-hour or so, or the 



30 THE PRESENT TREATMENT OF DISEASE. 

muriate of ammonium, which was used here, it proves 
a very valuable aid to the counter-irritation. The 
heart also needs stimulation, for the circulation is 
very much embarrassed, and for this purpose we are 
called upon to give moderate doses of alcohol. The 
patient has improved very much, and the urgent 
symptoms having passed away, we will now direct 
our attention to the condition of the kidneys. She 
will be given Basham's mixture, and her diet shall 
be made up largely of milk, though she will not be 
restricted exclusively to it. 



Prof. Da Costa had a clinical case, a man who, 
four months before, had marked oedema, and per- 
sistent albuminous urine. His condition had been 
entirely relieved, the albumen had disappeared from 
the urine. His treatment had been by remedies 
directed to removing the cedematous condition, and 
to the disease itself had been directed the following : — 

Sol. nitroglycerin, centesimal, gtt. j-iij. 

Sig. — With water ter die. 



In a case of acute nephritis, complicated with 
pleurisy, Dr. James C. Wilson, Physician to the 
Jefferson Medical College Hospital, said :— 



bkight's disease. 31 

Absolute rest is of primary importance. In the 
next place the patient should be put on a dietary 
which gives the largest amount of nutriment with 
the most limited requirements from the excretory 
organs. An almost exclusive milk diet will be given. 

What shall be given in the way of medicines ? It 
is necessary, in the first place, to relieve pain. This 
can be done by external applications. It is not safe 
to administer opium or morphia in large amounts in 
these cases. Opium must be given with extraordinary 
caution, because often the ursemic accidents to which 
such patients are liable are precipitated by the ad- 
ministration of opium, even in moderate doses. If, 
however, the pain is not relieved by external appli- 
cations, one or two grains of Dover's powder, repeated 
at hourly intervals, will be given. In regard to 
further medication, we must decide whether we are 
going to treat the pleurisy and ignore the condition 
of the kidney, or to treat the primary condition 
which underlies the general dyscrasia. Of course, a 
moment's reflection shows us that we should treat the 
cause, which is the condition of the kidnev. We 
want to produce elimination and get rid of the non- 
excreted waste substances with which the blood is 
charged. It is obvious that the kidneys which secrete 
urine the specific gravity of which is 1.004 and 



32 THE PRESENT TREATMENT OF DISEASE. 

loaded with albumen, are draining off the nutritive 
properties of the blood, and are allowing to remain 
in the blood those elements of waste which it is the 
function of the kidneys to excrete. He would there- 
fore make an effort to relieve the blood tension, for 
this drain of albumen is the result of the increased 
blood pressure associated with the condition of the 
vessels and of the heart. It is really a filtering of 
the albumen through the walls of the vessels with 
the watery portion of the blood. Another indication 
for treatment is the promotion of the elimination of 
the watery portions of the blood holding in solu- 
tion the waste products by other channels than the 
kidneys, for these organs are incapable of acting 
efficiently. 

He would therefore purge the patient. Weak as 
he is, it is proper treatment to administer those purg- 
atives which tend to produce large watery evacua- 
tions. For this purpose, he would order one drachm 
of the compound jalap powder, to be taken night 
and morning, and watch the result. If this fails, he 
would not hesitate to use elaterium. At the same 
time it would be advisable to cause sweating, which 
would also have a tendency to relieve the pleuritic 
trouble and aid in the depuration of the blood. He 
would therefore give small doses of muriate of pilo- 



bkight's disease. 33 

carpin, first administering by the mouth one-eighth 
of a grain once a day, and if this fails to promote 
free sweating, he would give the same dose or increase 
it to one-sixth or even one-fourth of a grain, hypo- 
dermically, and repeat it until the desired effect is 
obtained. The probabilities are that the patient will 
be benefited by this treatment. 

As the patient improves, he would, after a time, 
administer some form of iron, probably Basham's 
mixture in the dose of two fluid drachms three or 
four times a day. 

In a clinical case of Bright's disease, with general 
dropsy, Prof. Da Costa stated the following as the 
general plan of treatment : — 

The temperature is 100° ; skin moist, perspiring. 
The patient has been taking Basham's mixture, half 
an ounce three times a day. She is passing three 
pints of urine, about the average quantity. The 
Basham's mixture being a chalybeate tonic and a 
diuretic, will be the chief reliance here, as it also 
acts upon the skin. She shall have an occasional 
vapor bath, for the same purpose, and nourishing- 
food, principally milk and the like, including eggs, 
and a fair amount of underdone beef, to replace the 
drain from the kidneys. In order to relieve the 

3 



34 THE PRESENT TREATMENT OF DISEASE. 

kidneys to some extent, she shall occasionally have 
a dose of compound jalap powder ; and if the amount 
of urine falls much below the average, she shall have 
twenty-minim doses of fluid extract of jaborandi three 
times a day, to get free action from the skin. 



BRONCHIAL ASTHMA. See Asthma and Emphysema. 



BRONCHIAL CATARRH— BRONCHITIS, 

In the case of a man set. sixty-four, suffering from 
chronic bronchial catarrh, also beginning athero- 
matous degeneration of the arteries, Prof. Da Costa 
prescribed — 

Ext. pruni virginianse fluid., 
Tincturae gentianse comp., aa f5ss 
Acidi carbolici, gtt.j . M. 

Sig. — Ter die. 

For a boy fifteen years old, suffering from bronchial 
catarrh, he prescribed — 

Ammonii chloridi, gr.x 

Chloroformi, gtt.v 

Mist, glycyrrhizse comp., f5j. 
Sig. — Ter die. 

Turpentine was ordered to be rubbed upon his 
chest. 



BRONCHIAL CATARRH BRONCHITIS. 35 

Prof. Da Costa showed the class a very interesting 
case of a woman with a long history of ill health ; 
malaria, dyspnoea, and consolidation at the upper 
part of the right lung, etc. This was diagnosticated 
as general bronchial catarrh on the right, emphysema 
at the lower part and consolidation at the apex. The 
emphysema had stopped the consolidation. 

The catarrh was considered the most important 
point of the treatment. She was ordered — 

Ammonii chloridi, gr.x 

Tinct. opii deodoratse, gtt.iij 

Syrup, pruni virgin., f5j. M. 

Sig. — Every three or four hours. 

When the catarrh is well advanced toward recovery, 
let her take ten grains of the iodide of potassium and 
Sss of cod-liver oil three times a day. 



For a child with bronchitis, Prof. Bartholow 
prescribed — 

Lemonade, to be drank freely. 

Ammonii iodidi, gr.ij 

Syrup, picis, f5j. M. 

Sig. — Every four hours. 



Prof. Da Costa frequently prescribes codeia in half- 
grain doses, for cough. 



36 THE PRESENT TREATMENT OF DISEASE. 

In chronic bronchitis with asthmatic breathing, 
Prof. Bartholow prescribed, in the clinic — 

Ext. grindelise fluidi, 

Ext. quebracho fluidi, aa gtt.xx 

Ammonii iodidi, g r «v. M. 

Sig. — To be taken three times daily. 



BURNS. 

For burns, Prof. J. H. Brinton mentioned in his 
lectures the following dressings : Equal parts lime 
water and linseed oil ; white lead ; unsalted lard ; 
flour ; and as an elegant application for burns about 
the face especially, the following : — 

Olei amygdal. amar., gtt.ij 

Liquor, calcis, fSviij. M. 

Take fresh lard, wash out the salt under running 
water, and then beat up the lard with a little of the 
above solution. The lime water, agreeably flavored 
by the bitter oil of almonds, prevents the decompo- 
sition of the lard. 



CALCULUS. See Lithaemia. 



CANCER (CARCINOMA). 

Prof. Gross used with success absorbent cotton 



CARCINOMA. 37 

saturated with a one per cent, solution of citric acid, 
applied to the ulcer of carcinomata, to relieve pain. 



For the alleviation of hepatic cancer, Prof. Bar- 
tholow prescribed syrupus mangani et ferri iodidi, 
and minute doses of Donovan's solution ; the patient 
to avoid starchy, fatty and saccharine food. 



As an application after the removal of a cancerous 
growth from the uterus, Prof. Parvin advised — 

Iodinii, 

Brominii, aa 5j 

Acid, carbolic, crystal., Sss 

Alcohol., gj. M. 

Sig. — Apply by means of absorbent cotton. 



Prof. Da Costa has, from experience, formed the 
opinion that small doses, long continued, of corrosive 
sublimate retard the growth of gastric cancer. 



In a clinical case of cancer of the omentum and 
liver, Prof. Bartholow said, we should not pronounce 
a fatal sentence, but should assume the existence of 
a curable disorder. He would follow that beneficent 
rule in this case, and would use that remedy which, 
above all others, has the power of effecting the 



38 THE PEESENT TEEATMENT OF DISEASE. 

absorption of inflammatory and specific exudations. 
He would therefore tentatively give massive doses of 
iodide of potassium, by way of beginning the treat- 
ment. By massive doses he meant from twenty to 
forty grains three or four times a day. This is such 
a diffusible agent, that in order to make a profound 
impression, it must be given in large doses. He 
would order for this patient half a drachm of iodide 
of potassium three times a day, well diluted with 
water, so as to give the stomach as little distress 
as possible. The patient also suffers from constipa- 
tion, which should be relieved by enemata. 

Topical applications would be of no service if this 
diagnosis be correct ; but following out the beneficent 
rule already laid down, he would order the ointment 
of the red iodide of mercury to be used once a day 
until the characteristic action on the skin is produced, 
on account of its specific action, and because it un- 
questionably has the power of promoting absorp- 
tion. 

Another thing which should be done, as an aid to 
diagnosis, is to introduce into the mass an exploring 
trocar, and withdraw, if possible, some of its contents 
for microscopical examination. This can be done 
with perfect safety, and will probably settle the 
question as to the character of the growth. 



CATARKH, NASAL. 39 

CATARRH, NASAL. 

To diminish the sensibility of the mucous mem- 
brane of the nose, Dr. Sajous recommends — 

Acid, tannic, gr.xl 

Glycerini, fgj. M. 

Sig. — Apply with a cotton-wrapped probe. 

A solution of zinc chloride, gr. ij to fgj, is also 
useful, or of the zinc sulphocarbolate, gr. v to fgj. 

To get rid of effusion when the above is of no 
avail, he recommends that the patient sit covered 
with a sheet, and place a lamp within to steam him ; 
or use — 

3. 

Bismuth, subcarb., 

Pulv. talc, aa 5j 

Aluminis, 5ss 

Morph. sulph., gr.j 

Pulv. acacise, 5j. M. 

Sig. — Snuff up a little several times a day. 

He advised that a solution of common salt should 
never be used as a nasal spray, and not to use any 
nasal spray cold. He further stated that in almost 
any case where a wash was required, the following 
could be used : — 

Sodii bicarb., 

Sodii biborat., aa gr.iij 

Aqua?, fgj. M. 

Sig. — Use as a wash or spray. 



40 THE PEESENT TREATMENT OF DISEASE. 

Potassium permanganate, gr. ss, added to the 
above, would remove any bad odor which might 

exist. 

He treats post -nasal catarrh as follows : First a 

purgative, as sulphate of magnesia, 3ij; then use as 

a snuff ter die — 

Bismuth, subcarb., 

Pulv. acacise, aa 5ss 

Zinci sulph., gr.x 

Morph. sulph., gr.ij. M. 

Always caution a patient not to swallow when a 
fluid is being used in the nasal passages, for fear of 
injury to the Eustachian tube. 



Prof. Bartholow advised, in a case of catarrh of 
the nares, of specific origin — 

Sodii iodidi, gr. x 

Syrupi picis, f5ij. M. 

Sig. — Ter die. 

Also — 

Pil. ferri iodidi (U. S. P.) 
Sig. — One daily. 

Prof. A. W. Calhoun, of Atlanta, Georgia, treats 
nasal catarrh as follows : — 



CATARRH, NASAL. 41 

The patient was directed to cleanse the nostrils 
thoroughly with warm salt water twice daily, using 
both the anterior and posterior nasal douche, and 
immediately afterward the following, used in the same 
way : — 

Ammonii chloridi, giv 

Aquae, Oj. M. 

Sig. — Tablespoonful to douche. 

When the nostrils become accustomed to this, use 
a chlorate of potash solution of the same strength ; 
then after a time stop these, and alternate between 
the two following prescriptions : — 

**• . . 

Glycerini, §ij 

Acidi tanuici, q.s. 

Add as long as it will dissolve. 

3. 

Cupri sulphatis, 

Ferri sulphatis, aa 5j 

Aquse, foij. M. 

Ft. sol. 

Sig. — Begin (with each of the above) with five to ten 
drops to each doucheful of warm water, and gradually 
increase strength as high as patient can tolerate. 

After alternating between the last two for a time, 
he may use the following : — 



42 THE PRESENT TREATMENT OF DISEASE. 

Iodoform, pulv., 5j 

Extract, geranii, gr.x 

Acid, carbolic, gtt.xv 

Vaseline, Sj. M. 

Ft. unguentum. 
Sig. — Saturate absorbent cotton with it, and apply up 

the nostril at night. 



CATARRH, POST-NASAL. See Catarrh, Nasal. 



CATARRHAL FEVER. 

Prof. Da Costa had a protracted clinical case of 
catarrhal fever, affecting the gastro-intestinal mucous 
membrane, simulating typhoid. There was abdom- 
inal tenderness, the mind was dull and heavy, the 
temperature was very irregular, tongue heavily 
coated ; nausea and vomiting a marked symptom ; 
the bowels were constipated, and no eruption was 
ever found. The patient was almost cured by a 
regulation of diet, attention to secretions, calomel and 
quinine. She was ordered to keep the bowels open 
with oleum ricini and take a light bitter tonic, as — 

Acid, phosphorici dil., fSj 

Tinct. cinchona? comp., f§ij 

Elixir, simpl., fgj. M. 

Sig. — f5j before each meal. 



CEREBROSPINAL FEVER. 43 

CEREBRAL EMBOLISM.— CEREBRAL HYPEREMIA. 

Prof. Da Costa treated a case of cerebral embolism, 
causing right hemiplegia, with digitalis ; to aid in 
restoring the collateral circulation, potassium iodide, 
quinine and laxatives. He considers aconite the rem- 
edy for cerebral congestion, combined with bromides 
and laxatives, or even bleeding in the severer forms. 

In a case of cerebral hyperemia, consequent upon a 
blow, he prescribed the following active purgative : — 

9. 

Ext. colocynth. gr.j 

Capsici, gr.J 

Ext. gentianae, g r «U» M. 
Sig. — Ter die, in pill. 

At night, sodium bromide, gr. xxv. 



CEREBRO-SPINAL FEVER. 

Dr. James C. Wilson, Physician to the Jefferson 
Medical College Hospital, states that, in general 
terms, the treatment by the bromides, by opium 
or its derivatives, given early and in full doses, 
calomel occasionally, for its purgative effect, absolute 
rest and quietude, stimulus and artificial external 
warmth in the period of depression, and bland 
nutritious food in moderate quantities, promises, 
both in theory and by experience, the best results. 



44 THE PRESENT TREATMENT OF DISEASE. 

In cerebro-spinal meningitis, in which there is a 
marked febrile tendency, Prof. Bartholow says that 
gelsemium, in small doses of the fluid extract, is 
extremely useful. A uniform physiological effect 
should be maintained. 



CHANCROID. See also Syphilis. 

Prof. Gross treats chancroids, seen within a few 
days of their appearance, as follows : Wipe out the 
sore and under the edges thoroughly with cotton, 
then apply with another bit of cotton carbolic acid, 
being careful to touch all the raw surface and to get 
well under the undermined edges. The pain caused 
by this application is but momentary, and is followed 
by a sensation of numbness, which prevents pain 
from further manipulations. Now, with a bit of 
cotton wrapped on a match, touch the ulcer with 
strong nitric acid. This will destroy whatever poison 
there may be left. Protect with a bit of cotton. 
Have the patient bathe the penis in warm alkaline 
water three or four times per diem. If the prepuce 
covers the sore, let him use as a wash — 

Cupri sulphat., gr.J 

Acid, tannic, gr.ij 

Aquae, fSj. M. 



CHLOROSIS. 45 

Place a piece of cotton cloth between the glans 
and prepuce. A bubo can be aborted by injecting 
into it an eight per cent, solution of carbolic acid, 
and the use of compression. If already formed, it 
may be treated as the original sore. 

He states that iodoform prevents granulation in all 
ulcers, and does no good in chancroid except to 
relieve pain, and even in this latter case he prefers a 
solution of chloral, gr. iij to the ounce of water. 
As a stimulating application to a chancroid, he 
recommends the following : — 

Acidi tannici, gr.ij 

Unguent, hydrargyri nitratis, 5j 

Adipis benzoat., q.s. ad §j. M. 

Sig. — Apply on a piece of lint. 



CHILBLAINS. 

Prof. Bartholow highly recommends tincture of 
benzoin for chilblains. The part is to be well washed 
with soap and afterward with clear water, and 
thoroughly dried. Then the remedy, dissolved in 
glycerine, is applied. 



CHLOROSIS. 

In chlorosis, the following has often been found 
serviceable : — 



46 THE PRESENT TREATMENT OF DISEASE. 

Ferri sulphat. exsic., 3ij 

Quininse sulph., 3j 

Strychninse sulph., gr.ss. M. 

Ft. pil. xx. 
Sig. — One pill, three» times a day — (Bartholow). 

As a tonic for deranged nervous system, in a girl 
suffering from chlorosis, he prescribed — 

Strychninse sulph., gr.j 

Acidi phosphoric, dilut., f§j. M. 

Sig. — Ten drops in water, ter die, after meals. 



CHOLERA. 

Prof. Da Costa, in a lecture on this subject, 
expressed the following views: — 

Prophylaxis. — Since filth of all kinds leads to a 
rapid production of the germs, the locality should 
be rid of the same. The dejecta and cesspools 
should be disinfected. Inspect the source of water 
supply, since the germs can obtain easy access to 
wells. Drink only filtered water. Speedy burial 
of the dead should be urged. No change in diet is 
necessary. Live as usual. Better avoid stimulus in 
the prophylactic treatment. Among the disinfect- 
ants to be used are corrosive sublimate, zinc chloride, 
cupric sulphate, iron sulphate and permanganate of 
potassium. 



CHOLEKA. 47 

Internal Treatment. — Must check the early diar- 
rhoea if you desire to be successful, for, in most cases, 
if you stop this you put an end to the disease. For 
this purpose the most valuable remedies are sulphuric 
acid in combination with tinct. opii deod., with aq. 
menth. pip. In India the acetate of lead, gr. iv, with 
pulv. opii, gr. j, at once with the diarrhoeal outbreak, 
and continue every three hours until it checks the 
discharges. If the above cannot check the diarrhoea, 
use capsicum, gr. j, with opium and camphor. 

Second Stage. — Here we have cramps, vomiting, 
and purging. Now, stop the use of fluids ; allow 
but little ice in the mouth. This is a point of great 
importance. As little food as possible. Stimulus in 
small amounts, but frequently repeated. Mustard to 
the epigastrium. Administer every hour or two — 

Tinct. capsici, gtt.ij 

Tinct. opii deod., gtt.x 

Aquse caraphorse, f5ij. M. 

If the stomach does not retain the opium, give it 
hypodermically ; but, if possible, give it by mouth, 
since it appears to have a local effect. To relieve the 
cramps, use chloral subcutaneously, in large amounts. 
When reaction has set in, allow fluids, to wash out the 
kidneys. If he has not reacted, and is not doing 



48 THE PRESENT TREATMENT OF DISEASE. 

well under opiates, try calomel, especially in cases in 
which the secretions have not been arrested by opium. 
Give at first, gr. v to x, then order gr. i every 
hour or so. When the pulse is sluggish, the tem- 
perature below normal, use friction and a hot bath. 
In this the stage of collapse, stimulus will not be 
absorbed, or it would be of utility, though brandy or 
whiskey might be tried hypodermatically. 

Caffeine, gr. iss-ij, hypodermatically, stimulates 
the heart's action. If still the patient fails and the 
veins are swollen, etc., resort to blood letting ; but 
possibly the injection of fluids into the veins is 
better ; often the results are marvelous. The thick- 
ened blood is made to circulate. Use for this purpose 
the following : — 

Sodii chlor., 5j 

carb., 5iij 

Aquae, Ovj. M. 

Get it up to 108° Fahrenheit and a specific gravity 
of 1.005. 
Sig. — Throw in a few ounces at a time, until forty 

ounces have been injected. When the patient again 

flags, throw in a like amount. 

The inhalation of oxygen has done no good. 



Prof. Bartholow, after additional experience, affirms 
that there is no agent comparable to chloral for 



CHOEEA. 49 

Asiatic cholera. It is best to give coincidently 
morphina and atropina. In the condition preceding 
the algid stage strychnine is efficacious. It is best 
administered as the sulphate, combined with sulphuric 
acid. 

He considers that dilute sulphuric acid combined 
with laudanum is the best remedy in the preliminary 
diarrhoea of cholera. 



CHOREA. 

In a case of chorea at the Pennsylvania Hospital, 
Prof. Da Costa, in calling attention to the successful 
employment of hyoscyamine, said : — 

The ordinary remedies for chorea act slowly; 
arsenic, though one of the best therapeutic agents 
for this disorder, takes time, and the loss of time 
here may be fatal. He recalled a case of tremor 
which he had seen rapidly influenced by hyoscyamine, 
the active principle of hyoscyamus niger. He con- 
cluded to try it here. He ordered him to take one- 
two-hundredth of a grain, to begin with, a decided 
dose for a boy of his age ; but not finding any 
marked influence, he concluded that it would be 
advisable to increase the dose to the one-hundredth 
of a grain, given three times a day. The effect was 
admirable. From the first few days the boy began 



50 THE PEESENT TEEATMENT OF DISEASE. 

to improve, and at this time he had some dryness 
of the throat and wanted his mouth frequently 
moistened. He became brighter in his mind ; took 
more interest in what was going on ; moved volun- 
tarily in bed, and tried to help himself to food. His 
voice also returned, and he left his bed and began 
walking around the ward. After this, recovery was 
rapid and uninterrupted. He had no other treatment 
than hyoscyamine. 

Did the hyoscyamine produce the striking effect, 
or did the rest in the hospital do it ? That rest is 
good in all, and can cure many cases of chorea, is 
admitted ; but the improvement here was too sudden 
— coming on in three or four days — and too great to 
be attributed entirely to the good nursing and the 
food which he received. Hyoscyamine is a valuable 
antispasmodic and exercises a remarkable control 
over muscular movements. With the control of the 
movements the condition of the muscles is improved, 
and all the functions are increased. Even the blood 
has improved ; for, though still ansemic, he is not so 
much so as he was. Let him take for his anaemia 
the elixir of the pyrophosphate of iron, a drachm 
three times a day, and stop the hyoscyamine, as 
having accomplished its purpose. 

The treatment of chorea by hyoscyamine had 



CHOEEA. 51 

been successful in other cases, the usual dose at 
first being tfu- of a grain. 



In the case of a young man, aged twenty-one, 
suffering from a well-marked attack of chorea, that 
could not be linked to any history of rheumatism, 
but possessing a most irritable temperament, to which 
he attributed the cause of the trouble, Dr. O. P. Rex, 
Physician of the Jefferson Medical College Hospital, 
prescribed — 



Potassii iodidi, 
Extract, cirnicifugge fluid., 
Syrup, sarsap. comp., 
Aquae, aa 
Sig. — To be taken ter die. 


gr.vij 
gtt.xx 

f3j. 



M. 



For a boy aged eight years, with chorea, limited 
to the voluntary muscles, Prof. Bartholow ordered 
that the child be kept from school. A pill of the 
iron iodide was given ter die, also liq. potassii arsenit., 
gtt. iij, at first, then soon to be increased to gtt. v ter 
die, and again reduced to gtt. iij ter die. 

In another case, in a boy, he prescribed Fowler's 
solution, three minims three times a day, in com- 
bination with the fluid extract of gelsemium. In 
another case, with anaemia, he prescribed tincture 



52 THE PEESENT TKEATMENT OF DISEASE. 

of calumba, one drachm thrice daily, and Fowler's 
solution, three minims thrice daily, to be taken before 
meals, and after each meal one of the officinal pilulse 
ferri iodidi. 

He advised the trial of conine bromhydrate (dose 
gr. tW~A) in obstinate cases. 



Dr. J. C. Wilson, Physician to the Jefferson Medi- 
cal College Hospital, directed, in the case of a girl 
of fifteen, suffering from chorea, that chloral, in five 
grain doses, should be administered five or six times 
during the day, and that the patient maintain the 
recumbent posture as much as possible. She would 
then be placed on iron and arsenic, to be persistently 
used for a long time. 

A case of chorea, in an anaemic girl, set. eight, 
which followed diphtheria, was presented by Prof. 
Da Costa. The choreic movements were continuous. 
Rapid improvement followed the treatment, which 
consisted in — 

Arsen. chlorid., g r »roir 

Tinct. ferri chlorid., gtt.v 

Syrupi simplicis, q.s 

Aquae, ad f§j. M. 

Sig. — Ter die, after meals. 



CHOREA. 53 

In another case, in a girl not yet arrived at the 
age of puberty, who had suffered from this affection 
for two years, and had been taking arsenic, he 
prescribed atropia, gr. -h twice daily, used hypo- 
dermatically — morning and evening. This plan of 
treatment would speedily modify the convulsive move- 
ments. Good nourishing diet with strict attention 
to the bowels was also of importance. Should this 
treatment fail, preparations of zinc or bromide of 
nickel would be employed. 



Prof. Parvin treated a case of chorea as follows : — 

* . 

Liq. potas. arsenitis, gtt.ij. 

Sig. — Take at meals. 



Also — 




I*. 




Hyoscyamin. sulph., 


gr.-2+ir 


Sodii bromid., 


gr.v. 


Sig. — To be taken in solution ter die. 





M. 



In a clinical case of chorea in a child, with heart 
trouble, after rheumatism, Prof. Bartholow said that 
it is of the first importance to improve the condition 
of the blood, for if the blood is impoverished the 
heart will be irregular ; anybody with clinical 
experience will substantiate this fact. This child, 



54 THE PKESENT TREATMENT OF DISEASE. 

above all things, needs iron. As mitral lesion is 
present, we must also give remedies to improve the 
condition of the heart; for after a time the lesion 
which is now compensated should cease to be so and 
lead to disturbance of a serious kind. 

Pulv. digitalis, gr.ss 

Ferri redacti, gr.ss 

Ext. nucis vomicae, gr.J. M. 

in pill, three daily for a few days, and then to be 
reduced to two. In a short time she need only take 
one a day, but these remedies should be kept up for 
a long period of time. 



CIRRHOSIS OF THE LIVER. See Hepatitis, Interstitial. 



COLDS. See Coryza. 



COLIC. 

In a clinical case of flatulent colic, in an infant, 
Prof. Bartholow stated that a proper regulation of the 
diet is the first step, avoiding those articles of food 
which the mother considers so harmless, potato, bread 
and gruel, which undergo fermentation. In addition, 
he would order a prescription containing a capital 
remedy for colic in infants, one that is more efficient 
and less dangerous than the ordinary preparations 



colic. 55 

of opium — bromide of potassium dissolved in aniseed 
or peppermint water, or a mixture of the bromide 
with oil of aniseed, mucilage and acacia, glycerine 
and water, of which a dose may be given when the colic 
comes on. It may be ordered without fear, knowing 
that it is perfectly safe and can do no mischief, which 
cannot be said of the various soothing combinations 
and carminatives in common use in the nursery, 
which usually contain laudanum or morphia. 



In another very young child, suffering from colic 
and indigestion, he said that infants in this condition 
of feeble digestion — apepsie, as the French call it — 
are, as a rule, greatly benefited by brandy, and they 
are about the only specimens of humanity that are. 
This child should have fifteen drops of the best 
Cognac every three or four hours, always giving it 
after aliment, or after nursing. In these cases of 
apepsia in infants, good is also accomplished by 
pepsin ; it is one of the few instances where pepsin 
is beneficial. Every time it takes its aliment it 
should also have ten or fifteen grains of saccharated 
pepsin. 

These are the medicinal means required ; what are 
the hygienic ones? The child needs air, and it 
should be sent out in the open air and sunshine 



56 THE PRESENT TREATMENT OF DISEASE. 

daily. Moreover, the skin should be kept in good 
condition, by baths, friction and inunction. After a 
warm bath, if the skin is well rubbed with a little 
fat, it will improve the nutrition, and . here is a case 
in which inunction will especially prove of service. 
After the morning bath the skin may be well rubbed 
with a soft, dry towel, and then a teaspoonful of lard 
rubbed in. 

With proper attention to the medicinal and 
hygienic treatment of these cases, with careful 
regulation of the diet, the child will soon cease 
to look wan and exhausted. 



In other cases of infantile colic and irritation 
of teething children, he advised a combination of 
bromide of potassium, oil of aniseed and mixture of 
asafoetida, given pro re natd. 



In a case of hepatic colic with a tendency to the 
formation of biliary calculi, Prof. Bartholow pre- 
scribed — 

1$, 

Sodii cholat., gr.xxx-xl 

Extract, nucis vomicae, gr.iiss. M. 

Ft. pil. x. 
SiG. — One pill ter die. 



CONSTIPATION. 57 

The cholate of sodium will help to keep the bile in 
a soluble condition. To keep the bile alkaline and 
so prevent the further formation of gall stones, give 
persistently sodium phosphate or cholate. 



CONSTIPATION. 

In a clinical case of obstinate constipation, Prof. 
Bartholow said he would, in the first place, prescribe 
a pill consisting of the extract of nux vomica, 
extract of belladonna and extract of aloes, one each 
night. In order to render the passages uniform at a 
certain hour each day, the patient will be directed to 
go to stool at that hour, whether he has any inclina- 
tion or not. To assist in effecting this, he will take, 
each morning, one hour before breakfast, the fol- 
lowing : — 

Magnesii sulphatis, 5>j 

Acidi sulphuric, dil., gtt.xx 

Ferri sulphatis, gr.j 

Aquae, fgiv. M. 

He can also assist in starting the contraction of the 
bowels by rubbing and kneading the abdominal 
walls, just as uterine contractions may be stimulated 
in the same way. Daily faradic applications to the 
abdomen and rectum will assist materially in starting 
the action. By the use of these measures, the bowels 



58 THE PRESENT TREATMENT OF DISEASE. 

may be gotten into the habit of acting regularly, 
just as they had gotten into the habit of not acting. 



In a clinical case of constipation, Prof. Da Costa 
stated that the elixir of euonymin, or the fluid extract, 
produces some very satisfactory results, full doses 
being given at night. The constipation following 
typhoid is treated by small doses of fluid extract of 
belladonna, or the tincture, at night, with sweet oil, 
(§ss or gj) in the morning; or plain water enemata. 

For chronic constipation, he had found kneading 
the bowels to be far more effective than electricity. 
The best American water for this trouble is Saratoga 
Congress, but no water should be used continuously. 
Aloin is the best medicine, and nothing can be better 
than a pill of aloin, rheum, belladonna and capsicum, 
all in small doses. 

At the clinic, Prof. Gross gave the class the formula 
of an artificial mineral water suggested by the late 
Prof. Eobley Dunglison, and recommended it as 
capital for constipation. It is made as follows : — 

Magnes. sulphat., §iss 

Potass, bitartrat., 5j 

Ferri sulphat., 3j 

Aquae, Oij. M. 

SiG. — Take a wineglassful on arising. 



CONSTIPATION. 59 

A young woman came to Prof. Bartholow's clinic 
complaining of obstinate constipation, having no 
evacuation for a month or six weeks. She was 
placed upon — 



Ext. physostigmatis, 




Ext. nucis vomicae, 




Ext. belladonnse, aa 


g r -i 


Ext. aloes, 


g r -\j 


Ferri sulphatis, 


gr.ss 


Ft. pil. 




Sig. — To be taken ter die. 





M. 



The iron was added to the pill because the element 
of anaemia existed ; while, if the patient was plethoric, 
the addition of a small amount of tartar emetic would 
be indicated. In this case massage was advised also. 



In habitual constipation the following pill will be 
found of value (Prof. Bartholow) : — 

Resinse podophylli, gr.vj 

Ext. belladonna?, 

Ext. physostigmatis, aa gr.iij. M. 

Ft. pil. xij. 
Sig. — One pill each night. 



Dr. A. V. Meigs, in a paper recently read before 
the College of Physicians, recommended the following 
mild pill as very effective in some cases of constipa- 



Extract, belladonnas, 




gr.A 


Aloes pulv., 




g r -i 


Rhei pulv., 






Extract, nucis vomicae, 


aa 


g r -i- 



60 THE PRESENT TREATMENT OF DISEASE. 

tion. When taken for five or six days, three times 
daily, it produced copious evacuations. 
1$, 



M. 



Prof. Da Costa directed, in a case of impacted 
colon of one week's duration, that an injection should 
be used, of turpentine Sss, beaten up with the white 
of an egg and mixed with a pint of hot water, to be 
followed by simple hot water and salt. In case this 
treatment failed, warm sweet oil was to be used. 
Internally was given — 

Magnesii sulph., 9j 

Acid, sulphurici dil., gtt.ij 

Elixir simplic, 

Aquae, aa fSss. M. 

Sig. — To be given every half hour. 

At the next clinic the patient returned well, the 
cure having been accomplished by the injections of 
sweet oil and a pill of aloes, belladonna and colo- 
cynth, on the third day of the treatment. 



A woman presented herself at the clinic com- 
plaining of constipation consequent upon atony of 



CONSTIPATION. 61 

the lower bowel. Often she had been six weeks 
without a passage, and at no time in the last year 
had she had an evacuation under two weeks. Prof. 
DaCosta placed her upon the following treatment : — 

Magnes. sulph., gj 

Acid, sulph. dil., f5ij 
Ferri sulph., 5j 

Aquae, Oij. M. 

Sig. — A wineglassful ter die. 

She was also given strychninse sulph., gr. A, at 
meal times. 

A man suffering with intestinal torpidity was 
given, by Prof. Bartholow — 

Euonymiu, gr. iij 

Extract, colocynth. comp., gr. ij 

Hydrarg. chlorid. mitis, gr.j. M. 

Ft. pil. 
Sig. — To be taken at night ; and a pill each night after, 
of— 

Physostigmat., 

Extract, nucis vom., 

Extract, belladonnas, aa gr. J. M. 



A remarkable clinical case of constipation, conse- 
quent upon saturnine intoxication, was shown by 



62 THE PRESENT TREATMENT OF DISEASE. 

Prof. Da Costa, in which the physicians in charge 
had prescribed, without any relief, castor oil, mag- 
nesia, and five doses of podophyllin, of gr. I each. 
Following a plan suggested by Trousseau, he was 
placed upon — 

Magnes. sulph., 3j 

Acid, sulph. dil., gtt.ij-iij. M. 

Sig. — To be frequently repeated. 

Only a few doses were given, and the patient was 
relieved by most copious and profuse discharges. 

He prescribed, for a woman complaining of con- 
stipation and dyspepsia, the following : — 

Ext. belladonna?, gr-rV 

Strychninae sulphat., g r -A 

Pulv. aloes, gr-rir 

Olei cajuputi, gtt.j 

Extract, gentianae, q.s. M. 

Sig. — Oue pill ter die. 

Several times Prof. Da Costa ordered the following 
combination for constipation : — 

Ipecacuanha?, gr.J 

Rhei, gr.ij 

Extract, colocynth. co., gr.j. M. 

Ft. pil. 
Sig. — At bedtime. 



CONSUMPTION. 63 

When constipation is limited to the gastric trouble, 
use — 

Pulv. rhei, 3j 

M. 



Pulv. rhei, 


3j 


Quininse sulph., 


gr.x. 


Div. mas. in pil. x. 




Sig. — One at bedtime. 




. favorite laxative with Prof. Gross 


is — 


ty- 




Rhei pulv., 


g r -y 


Aloin, 


g r -i 


Podophyllin., 


g r -i- 


Ft. pil. 




Sig. — One at bedtime. 





M. 



As a cheap but useful laxative, Prof. Parvin 
advises the use of Sss-j of bran, in a little water, 
taken at bedtime. 



CONSUMPTION. 

Prof. Da Costa gives the following rules for the 
treatment of pulmonary consumption : — 

Hygienic Treatment. — Out-door exercise, good 
food, warm clothing ; climate of paramount import- 
ance. The best climate, by far, is that found in 
Egypt; Algeria is a good place. In this country, 
New Mexico, Southern California, South Carolina, 



64 THE PRESENT TREATMENT OF DISEASE. 

Thomasville in Georgia, Florida. Colorado, for some 
cases, is an excellent climate. Cases having a co- 
existing bronchitis do better in a damp and mild 
climate, as Florida, etc. The element of change is 
very useful. The Adirondacks is a fine place for 
those early cases in which there is no tendency to 
hemorrhage. He does not care much for the " milk 
diet," but allows it in conjunction with other things. 
Give plenty of meats, and alcohol in moderation, 
especially in those cases free from fever. Mix it 
with ol. morrhuse, to lessen the tendency to its abuse. 
Whiskey and brandy are the best stimulants here. 
You need not interdict smoking. 

Medicines. — 01. morrhuse is of great utility, by 
improving nutrition and also by affecting the tu- 
bercle. Do not use its substitutes, as glycerine, etc. 
Give fgss, ter die, one hour after meals. To disguise 
it, and to promote its ready absorption, give, gtt. x- 
xv, ether ; but this sometimes causes belching. Mix 
it with equal amount of malt or whiskey. When 
the appetite fails, stop its use for a while. Do not 
permit the oil to be taken in hot weather. 

Next in importance is arsenic in small doses in the 
early stages ; arsenious acid, gr. ¥ l, or gtt. iij Fowler's 
solution, ter die. In the late stages it will be of no 
avail. 



CONSUMPTION. 65 

A third remedy is iodine ; it should be more gen- 
erally used; liq. iodi comp., gtt. i-iij, ter die, with 
potassium iodide to alternate with it. When anaemia 
is present, and not much fever, use iodide of iron. 
It is very valuable. Push it up to the point of 
tolerance. Begin with gtt. xv of the official syrup, 
and push up to foj, ter die. 

Prof. Da Costa does not like the hypophosphites 
in the treatment of consumption. They have no 
special effect, as ol. morrhuae and arsenic have. In- 
halations of sodium benzoate are of no use. Carbolic 
acid and tar by inhalation are of some avail. 

Treatment of Special Symptoms. — Entirely too 
much is done for the symptoms. For cough we 
should give no expectorant, unless bronchitis exists. 
Since the cough is generally an irritative one, mor- 
phia must, in time, be given. Codeia, gr. i-£, in 
simple elixir, often has a wonderful effect and does 
not constipate. Prussic acid or fluid extract of wild 
cherry is very useful at times. We may combine 
the acid with morphia. Inhalations of oil of euca- 
lyptus give relief. 

Night Sweats. — Give atropia, gr. ^, at bedtime. 
Sponge off the body with hot water to constringe the 
vessels. Infusion of sage at night. Mineral acids, 
especially sulphuric acid. Zinc oxide, gr. ij, ter die. 



66 THE PRESENT TREATMENT OF DISEASE. 

Ergotin or fluid extract of ergot is better than mor- 
phia in some respects. It is more permanent and 
does not cause dryness. Give ergotin, gr. ij, ter die, 
the last dose at bedtime. 

Digestive System. — The patient often has vomiting. 
Two excellent remedies may be given, as carbolic 
acid or creasote, gr. i, four times per diem. Strychnia, 
gr. ^_, ter die, is also of great value. 

Diarrhoea. — Opium q. s., with bismuth 9j ; copper 
sulphate, gr. ^\ ; silver nitrate, gr. \ ; hypodermic 
injection of morphia, gr. T2~i, in the abdominal wall. 

The Throat in Phthisis. — It may be swollen, and 
the larynx the seat of ulcers, which may become 
tubercular. Drink demulcents, as Irish moss (5j to 
the Oj). 

He has confidence in local applications of iodoform 
and cocaine. Let the patient eat his meals while the 
parts are under the effect of cocaine. 

For irritative fever of phthisis — 

Quininse sulph., gr.iss 

Digitalis, gr.ss 

Opii, gr.J. M. 

Ft. pil. 
Sig. — Ter die. 



Prof. Bartholow said, in a recent lecture : Creasote 
is curative — I use the word advisedly — in a small 



CONSUMPTION. 67 

proportion of cases of the more chronic form of 
tuberculosis, and decidedly ameliorative in the rest, 
being useless in tuberculosis florida. He vaporizes 
it with iodine, by means of hot water (120°), and 
the patient inhales the vapor slowly and deeply, 
from a distance of from fifteen to twenty-four inches 
from the vaporizer. Or gr. iij-v may be given in a 
pill with tolu, three or four times a day, the dose 
being gradually increased until the urine is darkened. 
It is most valuable in chronic cases before the stage 
of softening. Its action is its influence on the bacillus 
tuberculosis, and the physicians of the Montpellier 
(France) school find it to be better than carbolic* 
acid for consumption. 



Dr. Sajous thinks the local application of cocaine 
the best means of affording relief, in laryngeal 
phthisis, to the distress in swallowing, and iodoform 
to promote the healing of the ulcers. 



For the sweating of phthisis, Prof. Bartholow 
advises : — 

Acid, gallici, 5ss 

Ext. belladonna?, gr.ij. M. 

Ft. pil. x. 
Sig. — Two pills at bedtime. 



68 THE PRESENT TREATMENT OF DISEASE. 

In a clinical case of phthisis supervening upon 
pleurisy, Prof. Bartholow stated that the use of 
ammonia is highly serviceable in these cases. The 
iodide of ammonium, given steadily for a long time, 
will assist materially in bringing about a better state 
of things, perhaps a vast improvement. The chest 
should also be painted with iodine. He would also 
recommend granules of atropia, gr. tJtf, night and 
morning ; or gr. Ttr each night, to prevent night 
sweats, and have a stimulant effect on the pneumo- 
gastric nerve. 

He considers nitrate of silver at the head of the 
list of remedies for the treatment of the diarrhoea 
of phthisis. 

Prof. Da Costa had a case of phthisis, at the 
Pennsylvania Hospital, due to the patient's occupa- 
tion, that of a tool grinder, and in whose sputum the 
bacillus tuberculosis was found. The man said he 
had known about one hundred men to die of " grind- 
ers' consumption," and that those engaged in that 
occupation only lasted about twelve years, as a rule, 
but he had stood it much longer. His father lived 
to be ninety and his mother over seventy, and his 
brothers and sisters were all healthy, so heredity 
could have nothing to do with the disease. 



CONSUMPTION. 69 

Prof. Bartholow lays down the following rules in 
regard to the administration of cod-liver oil : In 
consumption the mistake is often made of prescribing 
cod-liver oil in large doses and before meals. In 
the latter case it destroys appetite, and creates a 
repugnance for food. It should invariably be given 
after eating, and one drachm should be the usual 
dose. There is a limit to the capacity of the digestive 
organs as regards the assimilation of fat, and when 
given in excess it disturbs the digestion and produces 
diarrhoea. Given properly, it is particularly of use 
in incipient consumption, before destructive changes 
have taken place in the lung ; it is especially service- 
able in fibroid phthisis and chronic bronchitis ; the 
more chronic it is, and the less the range of temper- 
ature, the more may be expected of the remedy. 
The best form in consumption and atheroma of the 
arteries, is the emulsion with the lacto-phosphate of 
lime. It may also be given in whiskey, a table- 
spoonful three times daily, containing a drachm of 
the oil, or given as hot toddy. It is sometimes 
taken in a wineglass of ale, in black coffee, lemon- 
juice, or for children it may be given in the form of 
biscuit. The cardinal rule for the administration 
of cod-liver oil is to give it only in the amounts 
that the stomach can dispose of. Watch the evacu- 



70 THE PRESENT TREATMENT OF DISEASE. 

ations, and if any portion of the oil is passing 
unchanged, regulate the dose accordingly. 



CORYZA. 

Dr. Solomon Solis-Cohen, Chief Clinical Assistant 
Out-patient Department, Jefferson Medical College 
Hospital, in a paper recently read before the Phila- 
delphia Laryngological Society, states that the pro- 
perty possessed by belladonna, of checking secretion 
from mucous surfaces, long ago suggested the employ- 
ment of this drug in acute coryza. His own experience 
with atropine had been fortunate. It must be given 
early in the attack, and when so given is veritably 
abortive in nine cases out of ten. He had tried 
several methods of administration, employing gran- 
ules and triturates of tott gr. and jhs gr., and a 
solution of one grain of the salt to the ounce of 
water, of which the usual dose was four minims 
(gr. riir). The latter method is preferable with 
patients upon whose discretion we can fully rely, 
and to whom we feel no hesitation in intrusting a 
prescription for a poisonous drug. With other 
individuals it is safer practice to hand the patient 
three or four triturates or granules of the dose 
desired, writing explicit directions as to their use 
upon the envelop containing them. The manner 



CORYZA. 71 

of using the remedy which has proved most effica- 
cious, is to administer ihs grain at the first interview 
(if this be on the first or second day of the attack), 
and to repeat the dose in four hours, provided there 
be no dryness of the throat. The rule for the third 
dose is the same ; dryness of the throat or dilatation 
of the pupils being the indication to stop the remedy. 
When a case is seen during the first twenty-four 
hours, two doses will often bring the affection under 
such complete control that the patient does not 
resort to any further medication. Secretion of thick, 
yellowish mucus, requiring the occasional use of the 
handkerchief, will, however, usually persist for about 
a week, but there is, ordinarily, no embarrassment 
to breathing. Sometimes it is necessary to repeat 
the dosage in the same manner on the following 
day, the indication being renewal of watery dis- 
charge, suffusion of the eyes, and more or less 
" stuffiness " of the nose. In order to secure the full 
therapeutic benefit of the atropine in severe cases, it 
must be pushed until the physiological effect is 
produced ; that is, dryness of the throat and dilata- 
tion of the pupil. In one case tV gr. of pilocarpine 
hydrochlorate was administered by the mouth, with 
the effect of relieving the unpleasant sensations. 
Ordinarily, however, the dryness is readily over- 



72 THE PRESENT TREATMENT OF DISEASE. 

come by allowing a few pellets of ice to melt in the 
mouth, or by rinsing the mouth from time to time 
with cold water. 

More recently the effect of cocaine in emptying 
the engorged venous sinuses of the nasal mucous 
membrane has led to its employment in the treatment 
of acute coryza. While the relief is almost imme- 
diate, even in cases where there has been great 
obstruction to breathing, the effect passes away in 
from two to three hours. He had found the fluid 
extract of erythroxylon to be equally efficacious, if 
instilled into the nose in sufficient quantity. The 
alcohol of the fluid extract is, however, objection- 
able, producing considerable smarting. An infusion 
can be made of equal strength by the addition of a 
small quantity of glycerin, and by this means we get 
rid of all unpleasant effects not inseparable from the 
drug. The employment of a preparation of coca 
will give excellent results in connection with the 
atropine treatment. The patient is given a glass 
" dropper " slightly curved at the end, such as is 
used by oculists, and instructed to flood the nose 
with the infusion of coca whenever it becomes 
" stopped up." He is directed to draw the medicine 
back into the throat, in order to make sure of reach- 
ing the posterior ends of the turbinated bodies. In 



CORYZA. 73 

all cases, however treated, a brisk saline cathartic 
administered at the outset is found of the greatest 
advantage. 

Where cases are seen too late to employ atropine 
with advantage, good results have sometimes been 
obtained from ammonium salicylate in doses of ten 
to fifteen grains, repeated every second hour until 
tinnitus aurium is produced. Salicin, salicylic acid, 
and sodium salicylate have not seemed to be equally 
efficacious with the ammonium salt. 

In a few cases of influenza, in which the coryza 
has been quite severe, in some of which there has 
been much conjunctival distress, and in all of which 
headache and lassitude have been marked, though 
the febrile symptoms have been mild, cinchonidine 
salicylate has apparently been of great benefit, while 
the infusion of erythroxylon has been of inestimable 
value in relieving the distress occasioned by the 
nasal symptoms. 

As a useful prescription in " common colds " with 
cough, Prof. Bartholow offers the following : — 

Codeise, gr.j 

Syrup, scillse comp., 

Syrup, tolu, aa fSss. M. 

SiG. — A teaspoonful pro re nata. 



74 THE PRESENT TREATMENT OF DISEASE. 

He considers a combination of tartar emetic and 
opium, with a saline purgative, one of the best 
modes of treating an acute cold. 



The following treatment, by Dr. Sajous, was re- 
commended in some clinical cases of chronic coryza: 

Sodii salicyl., 5ij 

Sodii bibor., 5iij 

Glycerini, f§ss 

Aquse, q.s. ad f§vj. M. 

Sig-. — Of the above take f5ij and put into Oj warm 
water (100° F.). 

Of this latter solution, "snuff" into the nostrils 
as much as can be taken up in the hollow of one's 
hand, ter die. 

For the headache oftentimes present in a bad cold, 
he directs ten grains each of bromide of potassium 
and bromide of sodium, every two hours. 

For acute rhinitis in its incipient stages, of all the 
remedies tried by Dr. Sajous, the following has 
given the best results. In the doctor's words, "It 
acts like magic " : — 

Morphinse acetat, gr.iv 

Bismuthi subnit., 

Pulv. talc., aa 5j. M. 

Fiant chartse x x x. 
Sig. — Use as a snuff. 



DIABETES. 75 

He states that this prescription will check a very 
bad cold, or coryza, sometimes with only one sniff of 
the powder. 

CROUP, SPASMODIC. See Laryngismus Stridulus. 



CYSTITIS. See Genito-Urinary Organs. 



DELIRIUM TREMENS. 

Dr. Neff, at the Jefferson Medical College Hos- 
pital, treats this disease with beef tea, very hot, and 
with much red pepper in it. To obtain sleep he 
gives sodium bromide, 5j, and chloral, gr. x, or gr. v 
if the heart be weak. Repeat the sodium bromide 
in one hour, and both in two hours, if necessary. 



DIABETES. . 

In a clinical case of diabetes, under charge of 
Prof. Da Costa, at the Pennsylvania Hospital, he 
suggested some skepticism as to the reputed influence 
of remedies over diabetes, and especially the advan- 
tages of any particular drug. Hasty conclusions 
are frequently drawn from such cases while under 
very different treatment, because of a temporary 
diminution in the total amount of urine or of sugar, 
or of both. His rule invariably is to put the man 



76 THE PKESENT TREATMENT OF DISEASE. 

• 

upon a restricted diet alone, for a week or so, and 
order some harmless drug, like peppermint water, 
that the mental effect may not be lacking, to satisfy 
himself in regard to the case, and establish the 
amount of water and sugar excreted under the hos- 
pital regimen, in order to find out how much may be 
fairly claimed subsequently, as the result of the 
remedies. What has often been claimed as the 
result of medical treatment has been really attribut- 
able to the change in the patient's surroundings and 
his food. 

His advice, then, would be to try the patient upon 
a restricted diet at first, and if he has been already 
under medical treatment, stop it off altogether for 
the time, in order to establish his true condition. It 
is upon the diet of diabetics that chief reliance must 
be placed. What is that diet ? It is one devoid of 
sugar and of starchy substances, which easily are 
converted into sugar; one especially consisting of 
milk, eggs, green vegetables, etc. The great difficulty 
in establishing such a diet is the bread. The patient 
will learn to get along without sugar in his tea and 
coffee, and, indeed, they often get a distaste for sugar 
in tea and coffee. Sugar and fruits patients can give 
up, but with bread comes the battle. His advice 
would be to give a little bread occasionally. Theo- 



DIABETES. 77 

retically, it is inadmissible. Gluten biscuits, and 
similar preparations, aid in the attempt to cut off 
starchy food, but will not entirely take the place of 
ordinary bread. Graham bread has been recom- 
mended, and certain forms of foods for diabetics, but 
a little bread must be conceded to the patient, from 
time to time, that he may not be discouraged and give 
up the treatment. Diet alone will accomplish great 
results in diabetes mellitus. Under a restricted diet 
alone many patients may live for years in apparently 
perfect health. 

Of the remedies used two appeared to have done 
good, the salicylate of sodium, and afterward ergot ; 
but the lactic acid treatment had no effect at all. If you 
give a patient salts of sodium, potassium, magnesium, 
and his stomach tolerates the remedy, the total 
amount of sugar excreted will undoubtedly be re- 
duced. Some natural waters, Carlsbad, for instance, 
undoubtedly owe their beneficial effect in this com- 
plaint to the alkaline salts which they contain. 
Opium is undoubtedly a powerful agent in the treat- 
ment of diabetes ; but it should be held in reserve, 
for fear of making the patient an opium eater ; for to 
be curative it must be kept up for a long time. This 
patient has taken opium without obtaining as good 
results as he obtained from the other drugs men- 



78 THE PRESENT TREATMENT OF DISEASE. 

tioned ; but lie has not taken sufficient to fairly test 
the treatment, and Prof. Da Costa said he would now 
order Dover's powders again, but soon return to the 
salicylate. 

While keeping up the regulated diet and the 
special therapeutics, attention to the patient's gen- 
eral condition is of great importance. Watch the 
urine ; keep a faithful record of the varying propor- 
tions of the chief constituents, water, sugar and 
urea ; but, above all, pay attention to the functions 
of the skin, by baths and frictions, with or without 
inunctions ; flannel underclothing should be worn, 
to protect the patient from getting sudden chills. 
In connection with the other remedies that may be 
used, cod-liver oil will often be advantageous ; and, 
in conclusion, patients should refrain from drinking 
too much water, especially in the evening, in order 
that their rest shall be as undisturbed as possible. 



Prof. Austin Flint, Jr., in a recent paper on this 
subject, read in the Section of Practice, American 
Medical Association, stated that while the physician 
is justified in encouraging patients to expect relief, 
and even cure, in recent, uncomplicated cases, the 
diet is all important, and its regulation cannot be 
expected to be perfect without professional aid in its 



DIABETES. 79 

enforcement. A diabetic is never safe from a return 
of his disease, even when he believes himself to be 
cured; and under no circumstances should he pass 
more than a few weeks without an examination of 
the urine. 

The arsenite of bromine, or Clemens's solution, 
appears to be useful ; beginning with three drops 
three times daily in a little water, immediately after 
eating, gradually increasing the dose to five drops. 
This may be continued for weeks and months, with- 
out producing any unfavorable effects ; but the admin- 
istration of this remedy does not supply the place of 
the dietetic treatment, which should be enforced in 
all cases. A rigid diet should be continued for two 
months, at least, even in the mildest cases of the dis- 
ease. It may be necessary, in certain cases, to continue 
it for a longer period, even twelve or more months. 

The most unfavorable cases are those which occur 
before the age of puberty. An adult male presents 
the most favorable conditions for cure. In old 
persons, when the disease is of long standing, the 
dietetic treatment will secure practical immunity 
from nearly all the distressing symptoms, although 
the glycosuria may not be entirely removed. A 
study of any of the diet-papers recommended will 
make it evident that those who are able to follow the 



80 THE PRESENT TREATMENT OF DISEASE. 

required regimen, without regard to the cost of 
articles of food, present much more favorable con- 
ditions, as regards the prospect of cure, than persons 
in straightened or indigent circumstances. Diabetes, 
however, occurs in all classes, and is by no means a 
rare disease. A hospital devoted to such cases, where 
the dietetic treatment could be strictly carried out, 
would be a boon to the rich and poor alike. 



Prof. Da Costa gives the following as the medical 
treatment of diabetes : (a) Diabetes Mellitus. Do not 
use bromide of potassium ; it is valueless. Quinine 
is of no use. Opium is of value, and is one of the 
best agents, but care should be taken in its use. 
Codeia, gr. i-i ter die, is much used in France. 
Trousseau's plan, with strychnia, is very useful. 
The salicylate of sodium, gr. x-xv ter die, in com- 
pound spirits of lavender and water, is his favorite 
remedy. Ergot is useful, but less so than others. The 
alkaline plan, quite popular in Europe, is of value. 
Aloes or aloin should be used for constipation that 
may arise, (b) Diabetes Insipidus. 1. A course of 
iron, for its tonic effects. 2. Strychnia is very useful. 
3. Ergot gives the best results ; absolute cures follow 
its use ; f5ss-j of the fluid extract should be given 
ter die. When headache from it comes on, it must 



DIARRHOEA. 81 

be stopped, and strychnine should be substituted for 
it for awhile. This has made many permanent cures 
for him, the patients being watched for years. 



At the clinic, Prof. Bartholow reported a successful 
treatment of diabetes mellitus by Fowler's solution 
and the chloride of gold and sodium. He had seen 
good results in many cases from the latter remedy. 
It has been used for three centuries, but not used 
enough. The dose is the twentieth of a grain three 
times a day. The chloride of gold is hard to intro- 
duce into the system. 

Concerning a case of diabetes, Prof. Bartholow 
said : Withdraw all starchy and saccharine food 
from diet ; instead, use acid fruits and vegetables ; 
if patient can stand it, skimmed milk is the best 
diet ; certain mineral waters are useful, as the alka- 
line waters of Michigan and the Bethesda, of Wis- 
consin ; large quantities necessary ; especially good in 
fat subjects ; ammonium carbonate and sodium phos- 
phate, the chloride of gold and sodium, and cod-liver 
oil, likewise serve a useful purpose. 



DIARRHCEA. 

In chronic diarrhoea, Prof. Da Costa speaks favor- 
ably of the following remedies : 1. Bismuth, gr. x, 



82 THE PRESENT TREATMENT OF DISEASE. 

with opium, four times a day. 2. Mineral acids. 
3. Copper, zinc, silver, iron. Copper is very effective, 
given in the dose of gr. xV~i of sulphate, four times 
per diem. It nauseates at times. Zinc sulphate, gr. 
i-ij, guarded by opium, gr. i~i, is very useful. In- 
jections of zinc sulphate are of value. Silver 
nitrate, gr. i, or the oxide, gr. J, both with opium, 
is often efficacious. Iron does not agree with all — 
dose of sulphate, gr. ij, or Monsel's solution, gtt. 
iij-v, diluted. Solution of nitrate of iron, gtt. 
xx-xxx, four times daily. Turpentine has effected 
many cures in his hands — dose gtt. x, in emulsion. 
He does not use vegetable astringents. 

The routine treatment not long since in Prof. Da 
Costa's wards in the Pennsylvania Hospital* consisted 
in the use of a strict milk diet, with from one-fourth 
to one-third of a grain of the nitrate of silver, 
administered every two hours, in pill form. At 
the same time iodine ointment was applied to the 
patient's abdomen, twice daily. He had afterwards 
adopted a new plan of treatment, which had greatly 
improved his patients' conditions. This treatment 
has consisted in the injection of five minims of 
Magendie's solution of morphia into the abdominal 
walls every morning and evening. This method of 

* Medical Record. 



DIARRHOEA. 83 

treatment has given great relief to the patients. It 
was first tried a number of years ago, in some very 
obstinate cases of chronic diarrhoea, with very good 
results, better results than he had ever been able to 
obtain from the hypodermic injection of morphia 
into other parts of the body. 

In cases of obstinate diarrhoea, he had had excel- 
lent results from giving the sulphate of nickel, in 
doses of from one to two grains, four times a day. 



For the diarrhoea often attendant upon puerperal 
septicaemia, Prof. Parvin recommends the following : — 

01. ricini, 5j 

Tinct. opii, 

01. terebinthinae, aa gtt.v. M. 

Sig. — Take pro re nata. 



In a clinical case of infantile diarrhoea Prof. Parvin* 
said : In the treatment of this patient, the first thing 
is a complete change of diet ; let the condensed milk 
be abandoned, and let the child have instead cow's 
milk, diluted with one-third or an equal quantity of 
gum-arabic water, gelatine water, or albumen water ; 
when the diarrhoea is better, barley water may be 
used for the diluent. To dilute cow's milk with 

* Archives of Paediatrics. 



84 THE PRESENT TREATMENT OF DISEASE. 

water is one of the worst of practices in infant 
feeding, for by such great reduction of the nutritive 
properties of the milk a double quantity of fluid- 
must be taken, and thus indigestion result from 
overloading the stomach or from too frequent feeding. 
As to the artificial food for infants, it is impossible to 
say in a given case that one or another kind of food 
will prove best ; have as admirable theories as you 
please in the selection and combination of ingredients, 
the final test is in experiment, and the experiment 
sometimes sets at naught the wisest, most scientific 
theories. 

As to the nature of diarrhoea, it is simply an 
intestinal catarrh, not an inflammation ; its chief 
cause is the food that is given, and food appropriate 
to its wants will improve, if not cure, the diarrhoea. 
The stools when first passed are partly green, and in 
the medicinal treatment it is well to include some 
antacid ; if the stools become green after exposure 
to the air, no such indication in the treatment would 
be presented. For the first few days, give this infant 
an occasional dose of subnitrate of bismuth, prepared 
chalk and opium — about the thirtieth of a grain of 
the last, and two or three grains of each of the other 
ingredients. 

For the erythema, perfect cleanliness of the parts 



DIARRHCEA. 85 

is of first importance, soiled napkins to be promptly 
removed, and none but perfectly clean ones applied 
in their place ; then careful bathing and drying, 
after which thoroughly dust the surface with ly co- 
podium ; do not use starch for this purpose, as it is 
liable to form, with the moisture that exudes from 
raw surfaces, hardened masses and cakes, which are 
irritating, and are not easily removed ; but if you 
choose, mix the lycopodium with an equal quantity 
of oxide of zinc ; sometimes, by the way, an ointment 
of oxide of zinc proves better than any powder 
applied to the surface. 

What is to be done for the rectal prolapse ? With 
less frequent operations the liability to this accident 
is lessened; but when it occurs, let the tumor be 
bathed with cold water, and immediately replaced, 
and then have the child kept upon its back, if 
possible, for a short time, the thighs being kept close 
together. In case of paralysis of the anal sphincter, 
cold astringent injections will prove useful, and its 
persistence in spite of these may be met by injections 
of warm water containing one drop of tincture of 
nux vomica and five drops of the fluid extract of 
ergot, one or two each day. A recent and very good 
recommendation for the tenesmus that frequently 
is a prominent symptom in this rectal prolapse, 



86 THE PRESENT TREATMENT OF DISEASE. 

is the introduction of a suppository composed of 
iodoform. 

The second child now presented is twenty-three 
months old, and since it was fifteen months old it has 
been taking, according to its mother's statement, 
"table food." For two months the child has had di- 
arrhoea, the evacuations sometimes being as frequent 
as eighteen in twenty-four hours. These are of a 
brownish color, contain no hard lumps, no mucus or 
blood, and there is no prolapse of the bowel resulting 
from them. It has had fever occurring every other 
night, and for this quinine has been successfully 
given. There is a history of tuberculous disease in 
some of the near relatives, though not in any of the 
immediate ancestors. 

In the treatment of this patient the first thing is to 
insist upon no more solid food, especially pie, being 
permitted. Let the child have a liquid diet, such as 
milk and the lighter animal broths ; a daily bath and 
protection from cold by suitable clothing, and avoid- 
ance of exposure will be directed. The quinine will be 
continued, to guard against a return of the malarial 
attacks, and also as a useful tonic, and for the diar- 
rhoea the officinal chalk mixture in a dessertspoonful 
dose, a little tincture of krameria and the camphorated 
tincture of opium being added to each dose. 



DIARRHCEA. 87 

Prof. Bartholow, in commenting on a clinical case 
of summer complaint, said, if he were asked what is 
the best remedy, above all others, in the treatment of 
the summer diarrhoea of infants, he would answer, 
brandy, the best Cognac. It is also extremely ser- 
viceable in colliquative diarrhoea, and depression of 
the functions of life. It should be given, in either 
case, in considerable doses. 

The mineral acids are very efficient in sporadic 
cholera and summer diarrhoea. The indications for 
their use are the profuse and watery characters of the 
discharges, which are alkaline or neutral in reaction, 
due to outward osmosis from the serum of the blood, 
and the best of the acids is sulphuric acid given with 
opium. Hope's camphor mixture is also frequently 
used, especially in pulmonary diarrhoea, with benefit. 



In summer diarrhoea in adults, the following has 
been found useful : — 

Aquae camphorse, fSiij 

Tinct. lavand. comp., fSj 

Timet, opii., f5j-5ij. M. 

Sig. — Tablespoonful every hour or two. 



Prof. Bartholow ordered, for a patient with peri- 
odical diarrhoea, no pus or blood or mucus in the 



88 THE PRESENT TREATMENT OF DISEASE. 

stools, never any constipation, tinct. belladonnas, gtt. 
xv, bis vel ter die. 

When a paretic condition of the bowel is present, 
and atonic diarrhoea exists, he advises the use of — 

Tinct. aloes et myrrhae, f5vj 

Tinct. nucis vomicae, fSij. M. 

Sig. — f5ss, ter die. 

(For the Diarrhoea of Consumption, see Con- 
sumption) . 



DILATATION OF THE STOMACH. See Stomach, Diseases 
of. 



DIPHTHERIA. 

Prof. Da Costa, in lecturing upon this subject, 
gave the following valuable instructions as to the 
treatment of diphtheria : — 

Diphtheria may continue in an individual for a 
long time, relapses occurring from self-infection. 
Treatment must be preventive and individual. In 
the first place, the strictest isolation must be enforced : 
remove all unnecessary furniture, clothing and the 
like from the room ; disinfect the sputa, linen and 
everything from the patient, and, if possible, remove 
the paper from the walls and wash with some dis- 
infectant. Do not allow members of the familv to 



DIPHTHERIA. 89 

come in contact with well children, for fear the 
former may convey the poison to the latter. 

The individual treatment is both general and local. 
In the former, alimentation and stimulation are of 
the greatest importance, given, as in typhoid, every 
two or three hours, day and night. Alcohol is given 
to the point of tolerance. Begin with 5ss to 5j of 
brandy every hour; increase till heart and pulse are 
improved. The amount a patient suffering with 
diphtheria can take is incredible; a child, set. two 
years, has been given a tablespoonful of brandy 
every hour, and 5j is quite common. There is 
present a condition comparable to that found in snake 
poisoning. Begin the stimulus early. 

As to medicines, one of the earliest and best treat- 
ments is by potassium chlorate, 5j to 5iss per diem, 
in divided doses, well diluted. Next to this, either 
alone or combined with it, is tinctura ferri chloridi, 
gtt. x every hour or two, for a child set. ten years. 

The rising treatment now is with calomel. It con- 
sists in giving large doses frequently, not minding 
the free movements from the bowels. Give one grain 
every hour till twelve doses have been taken, then 
the same amount every second hour. This has been 
often tried in the laryngeal form, in larger doses, and 
is of especial utility in this variety of the disease. 



90 THE PRESENT TREATMENT OF DISEASE. 

Corrosive sublimate, gr. ?V to tV every hour, is a 
similar but hardly as effective treatment. 

Jaborandi is a very new remedy in this trouble. 
The idea is that when the patient sweats well the 
membrane will loosen. As it is very depressing, it 
is not safe unless the patient is quite strong. 

Locally, strong caustics have been abandoned. 
Cleansing, disinfecting gargles are the modern treat- 
ment. Carbolic acid, with borax and soda, may be 
used. Thymol holds a high place, never weaker 
than ten grains to the ounce. 

Thymol, 5j 

Glycerini, f3iij 

Aquse, fSiss. M. 

Sig. — Gargle. Dilute, if necessary. 

Boracic acid in solution is another good gargle. 

Permanganate of potassium, a favorite with the 
English, equal parts of lime water and glycerine, or 
two parts of the former to one of the latter, are very 
useful and grateful. When the patient is old enough, 
these are best used in the form of spray. Equal 
parts of Monsel's solution and glycerine may be 
used when the redness and swelling are very great. 
Do not scrape the membrane. 

The most prominent among the solvents for the 



DIPHTHERIA. 91 

membrane are lime, bromine and pepsine. Of lime, 
it is difficult to get enough. Bromine is too irritating. 
The remedy that has done best is a saturated solution 
of pepsine in the form of spray. 

Lactic acid, jaborandi and numerous other agents 
which have been used for this purpose, have some 
solvent power, but not enough. 

Complications or Varieties. — For nasal diphtheria, 
in addition to the ordinary treatment, carried on, if 
anything, more actively, keep the posterior nares 
well washed out with — 

Sodii sulphitis, 5iij 

Glycerini, f5ij 

Aquae, q.s. ad. fSiv. M. 

Pepsine may prove yet more effective. This 
washes away the membrane, checks decomposition 
of the same and prevents blood poisoning. Use 
with the post-nasal syringe, 

In laryngeal diphtheria, besides the ordinary treat- 
ment, the best results have been obtained by having 
the patient breathe fumes from slaking lime. Also 
an occasional emetic, while patient has sufficient 
strength, does good. 

Diphtheritic paralyses, with good management, 
usually recover. The blood is always deteriorated 



92 THE PRESENT TREATMENT OF DISEASE. 

and patient is anaemic. Give iron, nourishing food, 
red wines, strychnine for the paralysis, best hypo- 
dermatically, if patient is old enough. 



Prof. Bartholow* believes that there are two 
objects to be kept in view in the treatment of diph- 
theria : 1. To modify the course and shorten the 
duration of the disease ; 2. To obviate the tendency 
to death. 

1. The application of topical agents to the fauces 
and the administration of internal remedies according 
to symptoms. He entirely disapproves of caustic 
and acid applications, as inviting the disease to the 
adjacent portions of the mucous membrane by destroy- 
ing the epithelium. He does not think much of the 
value of benzoate of sodium. The application of 
sulphur, in the form of powder, by insufflation or 
by blowing it over the whole diseased surface as far 
as it can be reached, he believes to be a good treat- 
ment. He regards lime water and lactic acid as of 
value as solvents. Some pieces of freshly burned 
lime are put in water, and the patient directed to 
breathe the vapor as it rises, or a solution of lactic 
acid strong enough to taste distinctly sour is freely 
applied to the throat by a large mop. He places no 

* Medical Record. 



DIPHTHEEIA. 93 

value on the use of chlorate of potassium, or tincture 
of the chloride of iron, as faucial remedies. 

When gangrenous sloughs are thrown off from the 
throat, carbolic acid is indicated, a one per cent, 
solution — not stronger than one per cent. This 
solution may be applied either by mop or syringe. 
When the exudation extends into the nares, the 
spray of a one per cent, solution of carbolic acid is 
gently thrown into them and kept up until the two 
canals are pervious, thus preventing the extension 
and decomposition of morbific materials and the con- 
sequent swelling of the deep cervical glands and 
possible development of septicaemia. He thinks that 
it is only when the exudation extends into the nares 
that much good can be accomplished by topical 
applications. 

2. The prevention of the diffusion of the morbific 
agent, of the development of septicaemia, and of 
failure of the heart. With the earliest appearance 
of an exudation in the fauces, from two to ten grains 
of the bromide of ammonium are given every three 
hours. It is believed that the diffusion of this agent 
through the mucous membrane of the respiratory 
organs, and so out of the mouth, detaches the 
exudation. To prevent septic decomposition he 
advises the use of a drop or two of Lugol's solution, 



94 THE PRESENT TREATMENT OF DISEASE. 

in water, every hour or two. This drug is to be 
given when the exudation is fully developed and 
spreading. He uses alcohol steadily, pushing it in 
large doses as an antiseptic agent. Quinia is also 
considered valuable in this same connection. Prof. 
Bartholow does not believe in the extraordinary 
powers of chlorate of potassium in this disease, as 
claimed by many. He fears its injurious effects on 
the kidneys. 

As food, milk, egg-nog and beef tea are given 
freely about every three hours. 



In a clinical case of diphtheritic paralysis, affecting 
chiefly the muscles of the lower extremities, Prof. 
Bartholow said : The obvious indication is to restore 
the normal contractility, and by so doing restore the 
proper nutrition. The faradaic current should be 
used, and of a strength just sufficient to produce 
muscular movements. It should be used daily for 
a few minutes at a time. He cautions against 
using too strong a current, and against repeating 
it too frequently. If the current is too strong, 
irritability of the muscles is exhausted, and instead 
of being benefited they are injured. If possible, 
each muscle should be made to act in turn. 

If the battery is not accessible, there are other 



DIPHTHERIA. 95 

modes of treatment. Strychnia may be administered 
internally, and is often of value, but better than the 
administration by the mouth is the hypodermatic 
injection of this drug. Used in this way, it acts 
more quickly, and more thoroughly restores the 
consentaneous action between the nervous system and 
the muscles. In addition to these measures, massage 
and friction may be employed. Here again a word 
of caution is required. Massage is the mania of the 
day. Rubbing is very much overdone. A certain 
amount of friction and kneading is beneficial, but 
the irritability of the muscles may be exhausted by 
too much rubbing and friction, just as by an excessive 
use of electricitv. The diet should contain those 
articles which especially promote the nutrition of 
the nerve elements. It should contain a large amount 
of nitrogenous and carbonaceous elements. 

In a case of diphtheritic paresis in which the 
muscles responded to the faradic current, Prof. 
Bartholow directed that this form of electricity 
should be used regularly ; and internally should be 
taken — 

Strychmnse, gr.j 

Acid, phosphorici dil., foj. M. 

SiG. — Ten drops ter die. 



96 THE PRESENT TREATMENT OF DISEASE. 

In addition — 

Syr. hypophosph. cum ferro, f5j. 

Sig. — Ter die. 



Prof. J. Solis-Cohen * considers that the two main 
indications consist : 1. In keeping up a supply of 
nourishment and stimulants ; and 2. In providing 
for the detachment and discharge of the morbid 
accumulations when they threaten to occlude the air 
passages. The sick-room must be systematically dis- 
infected. This is done by free use of sprays of 
carbolic or sulphuric acid. Solutions of the sulphate 
of iron or some other disinfectant are kept in all the 
vessels which are brought into the sick-room to 
receive the discharges, the soiled clothing, refuse 
food and slops of the patient. 

He regards the chlorine compounds as of more 
efficacy in diphtheria than all other remedies. Of 
these he prefers the tincture of the chloride of iron, 
which must be administered at frequent intervals 
and in large doses — from five to thirty drops, accord- 
ing to age and vigor of patient, should be given from 
every half hour to every second hour, as the case 
may be. It is given in glycerine and water, or in 
diluted syrup of lemon. He prescribes chlorate of 

* Medical Record. 



DIPHTHERIA. 97 

potassium very frequently in this disease — in the 
form of chlorine mixture (made of an equal number 
of grains of the chlorate and of drops of hydro- 
chloric acid, in plain or aromatic water, or in the 
infusion of quassia). He always suspends the use 
of this remedy when there are any symptoms of 
renal irritation produced by it. 

He administers the hydrochlorate of quinia (in 
preference to the sulphate) as a tonic, antipyretic, 
neurotic and antiseptic. It is to be given in decided 
doses. When deglutition is painful it is given by 
enema, with proper augmentation of the dose. 

Alcohol, in the form of strong wine, or as brandy 
or rum, is regarded as of the utmost importance 
when the system begins to give way. It should be 
given after the earliest manifestations of decided loss 
of vigor. At this stage it is of more importance, for 
the time being, than any remedial agent. From fgss 
to foj of brandy are to be given at intervals of from 
fifteen minutes to three hours. As long as it is well 
borne it may be given to any extent short of intoxi- 
cation. Children readily take a sort of syrup of 
brandy made by burning it beneath a lump of sugar, 
which becomes melted in the process. At moments 
of sinking he regards carbonate of ammonium as 
valuable. He gives from two to ten grains by the 



98 THE PRESENT TREATMENT OF DISEASE. 

mouth, in syrup of acacia, or from eight to forty 
grains by the rectum. At moments of collapse the 
ammonia is given by intravenous injection. 

The sore throat is treated by pellets of ice placed 
in the mouth and renewed more or less cautiously. 
The use of ice compresses is not approved. It is 
thought better to apply warm cotton batting, spongio- 
pilin, or an actual cataplasm, or to anoint the neck 
with oil, lard, or cosmoline, care being taken not to 
abrade the cuticle, lest local infection arise as a 
complication. Morphia is administered when great 
pain arises. 

Morbid products in the pharynx and nasal passages 
undergoing detachment should be promptly removed. 
This morbid product is kept diffluent as much as 
possible, by maintaining an excess of humidity in 
the atmosphere of the room by keeping a steaming 
vessel of water on the stove. The uninvaded tissue 
should never be cauterized. Applications of the 
tincture of the chloride of iron should be made to 
the pseudo-membrane with a swab of cotton or sponge. 
After this application the attempt may be made to 
remove the deposit by gargle, spray, douche or 
syringe, employing lime water as the medium. Forc- 
ible removal of the deposit is not regarded as 
judicious. 



DIPHTHERIA. 99 

When the larynx is invaded, he keeps a constant 
stream of steam in motion directed over the patient's 
face. Whenever the respiration becomes obstructed, 
a few pieces of lime, about the size of the fist, are 
slacked by tbe bedside every hour or so, covering the 
vessel in which they are slacked with a hood of stiff 
paper, so as to direct the steam and particles of lime 
toward the mouth of the patient. 

The use of emetics is indicated in children, to 
provoke expectoration from the air passages in the 
act of vomiting; but the same indication does not 
occur in adults who are able to expectorate voluntarily. 
If successful, the emetic may be repeated, at intervals 
of six hours, as long as the indications continue to 
recur. Alum, ipecac and turpeth mineral are the 
most reliable agents, and may be tried in the order 
named, adhering to the alum if it prove efficient. 
Emesis should not be carried too far, or be repeated 
if ineffectual, as it exhausts the power of the system 
without any compensation in the discharge of morbid 
products. 

Should asphyxia be threatened, from accumulations 
in the larynx or trachea, tracheotomy is indicated, 
and, though most frequently unsuccessful in averting 
death, it facilitates due access of atmospheric air to 
the lungs, and often saves lives that would otherwise 



100 THE PRESENT TREATMENT OF DISEASE. 

be lost. The most careful attention is required after 
tracheotomy, to keep the artificial passage clear. The 
stimulating treatment and the lime inhalations should 
not be discontinued. The two main indications for 
favorable prognosis after tracheotomy are desire for 
food and ability to expectorate. All treatment should 
be subservient to facilitating these great ends. 



DYSENTERY. 

Regarding acute dysentery, Prof. Da Costa says, 
the best treatment is ipecac, not to exceed gr. xx 
every two or three hours, guarded with opium, and 
he has very remarkable results from this plan. It 
is especially good in puerperal dysentery, as Prof. 
Bartholow has pointed out. The opium plan (gr.ss 
every two hours) is good. Next is Rochelle salts, 
one ounce in divided doses in the first twenty-four 
hours, and less thereafter. This does not preclude 
the simultaneous use of small doses of opium. Both 
the ipecac, and the saline purgative plans should be 
abandoned in two days if no change in the condition 
of the patient is seen ; they are rapid or valueless 
in their action. Next comes bismuth subnitrate, 
gr. x-xx every two or three hours. The use of 
ice water injections three or four times a day was 
originated by Prof. Da Costa some years ago ; they 



DYSENTERY. 101 

are very valuable. Sinapisms are useless and blisters 
harmful. 

He placed a man with acute dysentery upon a 
diet of arrow-root, corn starch and broth ; an opium 
suppository, gr. j, morning and night, to which 
was added rest and — 

Plumbi acetat., gr.ij 

Ipecacuanha?, gr.J 

Pulv. opii, g r -i« M. 

Sig. — Give every two hours until blood disappears, then 
lengthen the intervals. 



Prof. Bartholow recommends the bichloride of 
mercury in dysentery of children, where the dis- 
charges are of fresh mucus streaked with blood, 
tenesmus being present. 



In chronic dysentery, Prof. Da Costa finds sulphate 
of copper, gr. rr~i, four times a day, combined with 
opium, to be very effective. Other remedies he finds 
useful are bismuth (the adult dose being gr. x, three 
or four times a day), especially in children, nitro- 
hydrochloric acid, zinc sulphate, argentic nitrate, 
iron sulphate or Monsel's solution (gtt. iij— v), or 
solution of the nitrate (gtt. xx-xxx). All except 
iron should be combined with opium. When other 



102 THE PRESENT TREATMENT OF DISEASE. 

things fail, small blisters over the spot of greatest 
soreness sometimes do good. The diet should contain 
no starches, fruits or vegetables. 



DYSMENORRHEA. 

In a case of dysmenorrhoea, neuralgic in character, 
Prof. Bartholow strongly advised the use of — 
B. 



Ext. belladonna?, 


gr.iv 


Ext. hyoscyami, 




Ext. stramonii, aa 


gr.v 


Quininae sulphat., 


3ij. M. 


Ft. pil. xx. 




Sig. — One pill ter die. 




For the same form of dysmenorrhoea 


, Prof. Parvin 


recommended — 




1^. 




Tinct. opii, 




Tinct. Valerianae, 




Spirit, setheris comp., 




Tinct. castorei, aa 


f5ij. M. 


Sig. — A teaspoonful every hour. 





DYSPEPSIA. 

After enumerating the causes of dyspepsia to be — 
1. Eating too rapidly ; 2. Drinking too much water 
at meal time ; 3. Improper food ; 4. Want of exer- 



DYSPEPSIA. 103 

cise ; 5. Too much tea and coffee ; 6. Too much 
tobacco ; — Prof. Da Costa gives the following rules as 
to the treatment: Underdone meats and but little 
bread. No sweets. Pepsin sacch., gr. v, at each 
meal. The mineral acids before meals, as muriatic, 
nitro-muriatic or phosphoric. Certain bitters, as 
nux vomica or strychnine combined with gentian or 
calomba. An alkali a few hours after meals when 
there is great acidity, but this should not be used 
too frequently. 

A case of aggravated dyspepsia with constipation 
was given by him : — 

Tinet. capsici, gtt.j 

Tinct. nucis vom., gtt.viij 

Tinct. gent, corap., f5j. M. 

Sig. — Ter die. With gr. ^ aloin at bedtime, and avoid- 
ance of a starchy diet. 

In atonic dyspepsia, he prescribed — 

Tinct. nucis vomicae, gtt.x 

Tinct. capsici, gtt.j 

Tinct. cinchonse comp., f5j. M. 

Sig. — Ter die. 

To this was added pepsin, gr. iij-v, with each 
meal. 

For a case of flatulent dyspepsia, he advised the 



104 THE PRESENT TREATMENT OF DISEASE. 

following course of treatment : Milk and underdone 
meats ; nothing starchy ; sacch. pepsin, gr. v, with 
meals ; also a pill of — 

Argent, oxid., gr.J 

Ext. nucis vomic, gr.J 

Pulv. capsici, gr.J M. 

Sig. — Ter die. 

A pill of aloin, gr. tV, every night, for accompany- 
ing constipation, which he considers the best remedy 
to keep the bowels open in dyspepsia. Or it may be 
taken in doses of gr. tu~1, twice a day. 



In a case of dyspepsia in a woman, forty-eight 
years of age, who had reached the climacteric, Prof. 
Bartholow stated that she should be placed on a diet 
free from fermentescible constituents. We should 
provide nothing which will contribute to the evolu- 
tion of carbonic acid gas. A great deal could be 
accomplished by restricting the diet to the most 
elementary constituents. What is the elementary 
diet ? It is that provided for the infant during the 
earliest period of life. This patient should adopt an 
exclusively milk aliment ; and, to render its digestion 
more easy, the cream should be removed. It should 
be skimmed once. To insure its digestion, one-fourth 



DYSPEPSIA. 105 

the quantity of lime water should be added, and it 
should be given every three hours, for this is about 
the time required for the digestion of milk. About 
a gill will be taken on each occasion. But living on 
an exclusive milk diet is not an enjoyable existence. 
After a few days there is a great desire for solid food ; 
there is a feeling of weakness or "goneness," and 
there is usually constipation. Notwithstanding these 
disadvantages, the patient should be encouraged to 
persist in the use of the milk. The proper rule is to 
continue the milk until the symptoms for which it 
has been prescribed disappear. That may be one, 
two, three, or even more, weeks. 

After this course of milk, which should be ex- 
clusive, the patient taking no other aliment, and, in 
fact, no other drink, she should add to the dietary 
such articles as are suited to her condition, such as 
beef tea, made by mechanical process, and white of 
egg. The yolk of egg should be avoided, as it con- 
tains fatty and other constituents difficult to digest. 

It is necessary to give remedies which will relieve 
the gastralgia and at the same time prevent the fer- 
mentation of certain constituents of the food. Creasote 
is one of the best remedies for this purpose. It may 
be combined with bismuth and glycerine. Glycerine 
has a decided power to prevent fermentation in the 



106 THE PRESENT TREATMENT OF DISEASE. 

stomach, and thus prevent the subsequent distention 
due to the evolution of gas. The subcarbonate of 
bismuth is better than the subnitrate. The pre- 
scription will then be — 



Creasoti, 




gtt.viij 


Bismuthi subcarb., 




5\] 


Glycerini, 






Aquae menthse pip., 


aa 


fSj. 



M. 

Sig. — To be well shaken, and a teaspoonful given every 
three, four, five or six hours, according to the persist- 
ence of the pain. 

Under the milk diet the constipation will be 
greatly increased. As a rule, it is better to relieve 
this by the rectal administration of remedies. Some- 
times a saline does very well ; a bottle of Congress 
or Pullna water or a little Epsom salts will be 
sufficient. Better than this is an enema at night, 
of half an ounce to an ounce of linseed oil, allowed 
to remain all night, and followed in the morning by 
an enema of soapsuds. Instead of linseed oil, an 
enema of castor oil suspended in mucilage may be 
used. 

Another remedy very efficacious in these cases, 
and which may be given in the prescription already 
mentioned, or separately, is arsenic. It has been 
found that in gastralgia and abnormal fermentation 



DYSPEPSIA. 107 

Fowler's solution of arsenic is exceedingly useful. 
It should be given in small doses, as one or two drops 
three or four times a day. 



Prof. Da Costa says that milk diet has never 
seemed to him as applicable to functional as to 
organic dyspepsia. He would leave it to the choice 
of the patient. Strychnia is one of the best, if not 
the most valuable, remedies we have in functional 
indigestion. Avoid sugars and starches. Onions, 
spinach and peas are well borne. A meat diet should 
be directed. 

In a case of functional indigestion, he advised the 
following course of treatment : — 

Acidi nitro-muriatici, f5ij 

Vini pepsin., fgiij . M. 

SiG. — A teaspoonful, ter die, at meal time. 



Prof. Bartholow advises the use of naphthaline, 
two to three grains, in pill form, for stomach fer- 
mentation. In some cases he gives dilute nitric 
acid, gtt. x, before meals ; and in one clinical case 
he prescribed glycerine, stating that it has decided 
power to prevent fermentation in the stomach, as 
has lately been shown. 



108 THE PRESENT TREATMENT OF DISEASE. 

For dyspepsia, Prof. Pancoast suggests the follow- 
ing combination : — 

Elix. pepsin, et bismuth., f§ij 

Ext. cinchonse fluid., fBj 

Elix. zingiberis, f§j. M. 
Sig. — Dessertspoonful at meal time. 



Dyspepsia may also occur as a symptom of kidney 
disease. In a clinical case under Prof. Da Costa's 
care, the patient was placed, for a time, upon a purely 
milk diet, with lime water, and that was very effective 
in stopping the vomiting ; he was subsequently 
allowed to eat eggs, and an albumenized diet, with- 
out meats. He was ordered five grains of pepsin 
after each meal, stopping all other prescriptions, and 
keeping him in bed. Partly with a view of improv- 
ing his blood, and partly to act upon the kidney, he 
was afterward ordered Basham's mixture, a table- 
spoonful three times a day. 



In a case of dyspepsia dependent upon the fer- 
mentative process established by devotion to a starchy 
diet, to the exclusion of meat, Prof. Bartholow said : 
In such cases all remedies will be absolutely useless 
without a rigid regulation of the diet ; we must make 
a careful study of the diet from the point of view of 



DYSPEPSIA. 109 

the various disorders. In this case, as soon as the 
diet was modified so as to exclude the offending 
articles, the patient commenced to improve, but as 
sure as she forgot her caution and used that food 
which she preferred, her bad condition became aggra- 
vated. In addition to regulating the diet, he ordered 
a mixture of carbolic acid, creasote and bismuth, 
suspended by glycerine. The glycerine here serves 
a double purpose, first, by arresting the fermentation 
(for it is, in itself, a good remedy for flatulency), 
and, secondly, it serves to hold the other drugs in 
suspension. This is an excellent combination for 
stomachal and intestinal fermentation. 



In another case of indigestion dependent upon 
acid fermentation, Prof. Bartholow ordered ten 
drops of diluted muriatic acid before meals, not 
after meals, for then it would only add fuel 
to the flame. We give acid before meals to reduce 
the acidity of the gastric juice ; it checks the 
formation of acid, in accordance with the well- 
known physical law, if you put an acid upon 
one side of an animal membrane, and an alkali 
upon the opposite side, there is rapid diffusion, and 
thus, availing ourselves of this fact, by giving acid 
before meals reduce the acidity of the gastric juice. 



110 THE PRESENT TREATMENT OF DISEASE. 

An acid applied to the mouth of a follicle, which 
normally excretes an acid fluid, will reduce the 
acidity of the glandular secretion ; this is a physio- 
logical law, as well as a clinical fact. Upon this 
principle he would conduct the management of the 
case, and with due attention to diet, and to the state 
of the bowels, would expect in a short time to 
effect a cure. 

In a case of intestinal indigestion, accompanied 
with fermentation in the small intestines, Prof. Bar- 
tholow said : We should, of course, correct the diet, 
cutting off rigorously all starch and sugar. What 
will be the consequence : there will be no fermenta- 
tion. For this paretic condition of the bowel, which 
allows the flatus to collect, he should prescribe mix 
vomica. The following prescription would be of 
great service : — 

Tinct. nucis vomicae, 
Tinct. physostigraatis, 

Tinct. belladonnse, aa f5ij. M. 

Sig. — Fifteen drops morning and evening. 

If the patient can be faradized every morning, so 
much the better ; one pole may be placed over the 
spine, or over the stomach, the other inserted into 






EMPHYSEMA. Ill 

the rectum ; it will have a decided stimulating effect. 
Under this treatment it might be expected that this 
case would be relieved. 



EMPHYSEMA. 

In a clinical case of this disease, Prof. Bartholow 
said that the proper regulation of the diet is of 
primary importance. If the patient take food that 
he cannot digest, the stomach becomes distended with 
flatus. The patient then goes to bed, and the breath- 
ing at once takes on this asthmatic character. He 
should not use a large quantity of drink at his meals, 
and should confine himself to such articles of food 
as do not readily undergo fermentation. Bread 
should be avoided, because it readily ferments in the 
stomach. A supper of bread and butter and coffee 
would almost inevitably lead to an asthmatic attack. 

His diet should consist largely of animal food, 
lightly cooked and in most digestible form ; avoiding 
substances which fill the stomach without contributing 
much to the nourishment of the body. The supper 
is particularly important. If he should even drink 
a quantity of milk at night he would have an attack 
of difficult breathing. Food must not be given in 
large quantities at a time, and it should not be of a 
kind easy to ferment. 



112 THE PKESEOT TKEATMENT OF DISEASE. 

He should take a hypodermic injection of morphia 
(gr. iV, .005 6m.), and atropia (gr. rh 3 .0005 Gm.) ; 
for the relief of the paroxysm there is nothing com- 
parable to it. It is much more effective than the 
pastilles commonly used, which contain belladonna 
leaves and nitre, which, when burned, produce a 
smoke that irritates the bronchial tubes, although 
they do allay the trouble by acting upon the nervous 
system. 

The iodide of ammonium, on account of its effect 
upon the bronchial mucous membrane, and arsenic, 
for its influence upon the organs of respiration, will 
greatly ameliorate the symptoms. This peculiar 
action of arsenic has long been known. The moun- 
taineers of Styria attribute their powers of endurance 
to its use, and assert that the difficulty in breathing 
in ascending mountain heights is less in those who 
take the arsenic than those who do not. By the 
general improvement in nutrition and the powers of 
respiration, arsenic would be of service in this case ; 
but its effects should be carefully watched. It will 
be greatly aided by some volatile expectorant, which 
will aid the lung in getting rid of this viscid secretion. 
One of the best of these is eucalyptol, which may be 
given in capsule (five minims) four times daily. Its 
effect is at first tonic, and secondly specific, because, 



ENDARTERITIS. 113 

being eliminated by the mucous membrane of the 
lungs, it comes directly in contact with the affected 
tissues. 

The iodide of ammonium also acts upon the pul- 
monary mucous membrane, and makes the secretions 
thinner. Under this treatment he may go for months 
or years without any attack of asthma, and may 
fancy himself cured ; but if he take a cold and 
bronchitis is set up, the old trouble will be on him 
again. 



ENDARTERITIS. 

As a cardiac and nervous sedative, Prof. Bartholow 
prescribes five drops of the deodorized tincture of 
opium every four hours. To arrest the usually 
accompanying condition of chronic arteritis, the 
hypophosphites, cod-liver oil and quinia are em- 
ployed. One fluidrachm of the lactophosphate of 
lime and three minims of Fowler's solution are given 
thrice daily, in addition to the opium. When any 
improvement is visible in the condition of the patient, 
quinia is given in energetic doses. It has been 
shown to have a good effect upon the coats of the 
arterioles. 

In the case of a man fifty-eight years old, suffering 
with chronic arteritis, he prescribed — 



114 THE PRESENT TREATMENT OF DISEASE. 

**• 

Amraonii carbonat., gr.v 

Liquor, ammonii acetatis, f§ss. M. 

Sig. — To be taken ter die, for some months. 

In addition, he was advised to take, for his general 
condition, a drachm of compound syrup of the phos- 
phates, ter die. 

Prof. Bartholow says that, in the earlier stages of 
chronic endarteritis leading to changes in the nutri- 
tion of the brain, cod-liver oil combined, with the 
carbonate and iodide of ammonium is of very great 
value. In a case of this kind he prescribed, with a 
view of reducing the plastic element of the blood, 
the following, from which he had seen remarkable 
effects : — 

9- 

Ammonii iodidi, gr.v 

Ammonii carbonatis, gr.x 

Liq. ammonii acetatis, fjss. M. 

SiG. — To be given three times daily. 

This treatment should be kept up for several 
months. The object is first to aid in the absorption of 
the thrombus, and assist the vessels in increasing the 
nutrition of the brain. Otherwise areas of softening 
may form, and progressive degeneration ensue. 



ENDOCARDITIS. See Heart, Affections of. 



ENTERITIS, MEMBRANOUS. 115 

ENTERITIS, MEMBRANOUS. 

Prof. Da Costa, in a clinical case of this disease, 
said that it was difficult of cure. He advised, every 
night, a piece of confection of senna, and for the 
pain — 

Tinct. bellad., gtt.iij 

Tinct. cinchon. comp., f5j. M. 

Sig. — Ter die. 

He had found membranous enteritis to very often 
occur associated with hysteria in women. Which is 
cause and which is effect he is not certain. The 
diagnosis depends on finding the membrane in the 
stools ; aphasia, tetanus, vertigo, loss of memory and 
other nervous symptoms occur. 

Several clinical cases of membranous enteritis were 
presented by him, the treatment of which consisted in 
keeping the fecal accumulation in a soluble state by — 

Magnes. sulph., 5ij 

Ferri sulph., 5ij 

Aquae, Oij. M. 

Sig. — Take, every morning, f§ss. 

Also — 

Liq. potassii arsenitis, gtt.ij 

Tinct. ignat. amarse, gtt.vj 

Tinct. cinchon. comp., f5j. M. 

Sig. — Ter die. 



116 THE PEESENT TREATMENT OF DISEASE. 

ENTERO-COLITIS. 

Dr. J. C. Wilson, Physician to the Jefferson 
Medical College Hospital, in a case of chronic en- 
tero-colitis, suggested the following plan of treatment, 
the patient being four years old : — 

Hub over abdomen, which is greatly distended, 
gss ol. morrhuse, bis die. Before applying, the oil 
should be slightly heated. 

Diet — Expressed juice of meat and milk, contain- 
ing pancreatin. A teaspoonful of whiskey, in milk, 
twice daily, was advised, and of bismuth subnitrate, 
gr.iij, four times daily ; twice daily, a suppository : — 

Pulv. opii., gr.J 

Quininse bisulph., gr.ij. M. 

(See also Ileo- Colitis.) 



EPIDIDYMITIS. 

The treatment of epididymitis is thus outlined by 
Prof. J. H. Brinton : First give dose of salts ; apply 
lead water and laudanum; place American leeches 
on the cord, to relieve inflammation ; let the patient 
lie on his back. Now cover the testicle with a 
cloth saturated with mercurial ointment. If pain 
is severe, put some belladonna with the ointment. 

The above is not the treatment for gonorrhoea! 
epididymitis. (See Gonorrhoea.) 



EPILEPSY. 117 

EPILEPSY. 

In treating mild cases of epilepsy, Prof. Da Costa 
gives the bromides during two weeks of each month 
only ; in case the patient is a woman, the week pre- 
ceding and the one following the menses. During 
the remainder of the month, a salt of silver, or zinc 
oxide, or arsenic, or strychnine, or, what was a fa- 
vorite of Trousseau, belladonna to the point of toler- 
ance. Prof. Da Costa had a patient who had taken 
the bromides continuously, scarcely missing a dose, 
and had gained rather than lost in intelligence. Of 
any single bromide, he considers that of sodium the 
best, but is partial to a combination, such as the fol- 
lowing : — 

3. 

Potass, bromid., gr.x 

Sodii bromid., gr.xv 

Ammonii bromid., g r « v - M. 

He also frequently prescribes, in the same disease, 
five grains of the effervescing bromide of nickel, ter 
die, especially in cases of epilepsy of long duration. 
In the Hospital, he found bromide of nickel, in 
small doses (five grains ter die), remarkably efficient 
in the treatment of epilepsy occurring at the menstrual 
epoch. 

For epileptiform attacks, due to sunstroke, he 



118 THE PRESENT TREATMENT OF DISEASE. 

directed that tinct. belladonna, gtt. iij, be taken 
ter die. Patient to keep out of the sun. 

In a case of vertiginous epilepsy, consequent upon 
a severe blow, he prescribed — 

Potassii iodidi, gr.v 

Potassii bromidi, gr.xx. 

Sig. — In syrup and water three times a day. 

In addition, saline purgatives in the morning to 
lessen blood pressure. 

For a child two and a half years old, with in- 
fantile epilepsy, he ordered drachm doses of cod-liver 
oil twice daily ; also the following : — 

Potass, bromid., gr.iij 

Potass, iodid., gr.j 

Syrup, zingib., 

Aquae, aa q.s. M. 

Sig. — Ter die. 



Prof. Bartholow prescribed for a child set. four 
years, suffering with epileptic seizures, and having 
a pale retina, picrotoxinum, gr. tV, morning and 
evening, along with rigorous attention to diet. This 
drug often acts admirably in such cases when the 
bromides have failed, 

In a case of epilepsy, complicated with anaemia 



EPILEPSY. 119 

and intestinal irritation of a gaseous character, he 
ordered the following pill : — 

9. 

Ferri sulphat., gr.j 

Ex. nucis vom., 
Ex. belladonnse, 

Ex. physostigrnatis, aa g r 'J« M. 

SiG. — To be taken three times a day. 

If there is constipation, half a grain of extract of 
aloes will be added. Some of these remedies act on 
the longitudinal and some on the circular fibres of 
the muscular layer of the bowel. The relief of the 
intestinal disorder and the correction of the anaemia 
will probably suffice to prevent the recurrence of the 
attacks. Nothing is more fatal to the effects of treat- 
ment than the attempt to treat symptoms. If the 
theory of the case be the correct one, there are good 
grounds for believing that when the morbid chain 
between the peripheral nerves and the spasm centre 
is broken, the convulsions will cease. 

In another clinical case of epilepsy, he said : If 
there be any secret in the treatment of epilepsy, it is 
in regulating the diet. He was sure that more good 
had come from attention to this one point than from 
anything else. Drugs have a trifling potency com- 
pared with a rigid diet. The meals must be small at 
a time, meat only once daily, and the stomach should 



120 THE PRESENT TREATMENT OF DISEASE. 

never be overloaded, while large draughts of liquid 
must be avoided, even of water. Fatty food should 
be interdicted, and but small quantities of starchy or 
saccharine matter allowed. For drugs, we must 
remember that this woman is approaching the cli- 
macteric period, and that the attacks are growing 
worse, hence drugs must be directed toward allaying 
any irritability of the sexual system. This can be 
best accomplished by the use of bromide of sodium, 
one drachm, morning and evening, for the first week, 
and after that one drachm daily, in two doses. 

Prof. Bartholow, in a clinical case that had resisted 
treatment by the bromides, said : In a case of epilepsy, 
if the bromides fail, especially if the patient be 
anaemic, give strychnia and push it. Notwithstand- 
ing large doses of the bromide were given, the 
attacks persisted. She was ordered strychnia, in 
one-thirtieth of a grain doses, thrice daily ; and since 
she has taken it, she has had no more seizures. 
Besides the strychnia, he had insisted upon a rigid 
regulation of the diet. She had been taking nour- 
ishing but unstimulating food, without coffee and 
tea, and with meat only at dinner, and not in large 
amount; this latter is a concession to her anaemic 
condition, for in many epileptics meat must be 
entirely prohibited. 



EPILEPSY. 121 

In a clinical case of nocturnal epilepsy, he 
stated that the treatment should be partly medical, 
partly hygienic. The patient should have less 
tobacco and more oxygen. He should eat a light 
supper, substituting milk and water for tea; and 
to relieve this irregularity of circulation in the 
brain, take the bromide of potassium, which acts 
by gradually shutting off the blood. Besides this, 
it will relieve him of the terrible dreams and night- 
mare which aggravate his condition. You can almost 
always stop night terrors in children by full doses of 
bromide of potassium. Let him take a drachm at 
bedtime each night ; this can be increased if neces- 
sary. The period of full action of the salt can be 
ascertained by the insensibility of the pharynx. If, 
by touching the fauces with a spoon, no reflex action 
is produced, the full impression is known to have 
been obtained. (See also Hystero-epilepsy.) 



EPISTAXIS. See Hemorrhage. 



EPITHELIOMA. 

Prof. Bartholow mentioned a case of epithelioma 
treated by carbolic acid, after being removed twice in 
one year, and apparently well at the expiration of 
six years ; also a case of schirrous cancer treated, 



122 THE PRESENT TREATMENT OF DISEASE. 

after two removals, by carbolic acid, in which a cure 
was effected, the pathological condition disappearing, 
and the enlarged adjacent glands gradually lessening 
to their normal size and state. He threw a five per 
cent, solution deeply under the growth, so that it 
might get to all the adjacent tissues. 

In the general treatment of epithelioma, he is 
assured of the efficacy of arsenic, given internally, 
and injected into the immediate vicinity of the mor- 
bid growth. Chlorate of potassium, in impalpable 
powder, dusted on the cleansed and dried ulcer of 
epithelioma, is said to arrest this disease. It is also 
serviceable in rodent ulcer, and he considers it supe- 
rior to iodoform for chancroid ulcers. 



ERYSIPELAS. 

Prof. Da Costa, in lecturing upon this subject, gives 
the following modes of treatment in erysipelas : To 
modify a case there are several plans of treatment, to 
wit : 1. The old but still useful method of purging by 
diaphoretics and diuretics. 2. Quinine, grs. xii-xvi, 
in twenty-four hours, is of much value. 3. Tinct. ferri 
chloridi, in large doses, gtt. xx, every three or four 
hours. This is an admirable plan. 4. Pilocarpine : 
inject gr. &~i under skin. Great success followed the 
use of this remedy in several cases. The fluid extract 



ERYSIPELAS. 123 

of jaborandi may be used when pilocarpine cannot 
be obtained. In the cases with delirium, stimulate 
freely. 

At a recent clinic, Prof. Gross said : " There comes 
a time in the history of every hospital when septic 
diseases make their appearance. Erysipelas and 
septicaemia have appeared in this Hospital this winter, 
and I now use antiseptic precautions. The antiseptic 
used was bichloride of mercury, roVs solution. After 
being once used the sponges were cleansed as follows : 
They have water run over them for twenty- four 
hours, and are then thoroughly washed in a solution 
of sodium carbonate (one pound of the salt to a 
gallon of water), and are soaked in the same for 
twenty-four hours. This removes the fibrin. After 
soaking in a -nnnr solution of bichloride of mercury 
for a week longer, they are again used." 



In the treatment of surgical erysipelas, Prof. Gross 
reported favorable results from the hypodermic use 
of pilocarpine, first introduced by Prof. Da Costa in 
the treatment of the idiopathic form of the disease. 
He has, however, had no case of erysipelas since he 
began the antiseptic treatment of wounds. 



124 THE PRESENT TREATMENT OF DISEASE. 

As a local application in erysipelas, Prof. Bar- 
tholow recommends the use of unguentum hydrargyri. 



Prof. Da Costa, in a case of acute erysipelas,* 
referred to the remarkable result from pilocarpine, 
introducing a novel treatment of erysipelas. He 
intended to exhibit the case as a case of erysipelas, 
but he found that the erysipelas was gone. The 
treatment had proved more quickly efficacious than 
he supposed it would. The patient was ordered tinc- 
ture of the chloride of iron, twenty drops every three 
hours, but only received one dose. As the disease 
was rapidly spreading, and something was needed to 
make a prompt impression, another and more active 
agent was employed. He received, hypodermically, 
one-sixth of a grain of the muriate of pilocarpine. 
The result was remarkable; the temperature fell 
from 102° to 99 h °. He sweat profusely for an hour 
and a half, and there was no further development of 
the erysipelas ; not only did it not spread further, 
but what did exist quickly subsided. No local treat- 
ment was employed, not even cold applications; 
therefore, whatever success was obtained was from 
the pilocarpine. 

As long as five years ago he had used jaborandi in the 

* Medical Times. 



ERYSIPELAS. 125 

treatment of erysipelas until sweating was produced, 
and, lie thought, with the result of checking further 
development. In one case with high temperature 
the disease had already made some headway, and did 
not subside so quickly. Under the use of iron the 
disease had not been controlled, but the fluid extract 
of jaborandi, given every two hours, checked it. He 
had since used the jaborandi in connection with the 
iron at times, with good results. Jaborandi and pilo- 
carpine, its active principle, are, of course, similar in 
their effects. 

He would order in a case of erysipelas in its 
beginning the use of pilocarpine. It had saved this 
man a long and dangerous illness. It should be 
borne in mind that, in order to be fully effective, 
profuse sweating must be produced. 

In lecturing upon another case, he stated that 
pilocarpine had been of special service, in his hands, 
in cases in which the heart is not feeble nor the 
vitality depressed ; and in those in which there is an 
acute beginning with high temperature, and with a 
tendency to rapid spreading. The demonstrated 
value of the pilocarpine treatment in this class of 
cases renders it probable that it may also be of 
service in surgical erysipelas, and he had recom- 
mended it to the surgeons for trial. 



126 THE PKESENT TREATMENT OF DISEASE. 

Prof. Bartholow stated in regard to a clinical case 
of facial erysipelas, that the treatment of erysipelas 
should always be conducted with reference to the 
systemic condition of the patient. In an ordinary 
case, it will suffice to place the patient at rest, order 
a suitable diet, and keep the bowels open ; but if the 
case is more serious, there are three remedies which 
may be used with advantage. The first is bella- 
donna. This drug produces a condition of the skin 
and vessels directly in antagonism to that which 
exists in erysipelas. We will often be surprised 
to see how speedily the erysipelas disappears after 
the development of dry mouth, dilated pupil and 
flushing of the skin. If there be any systemic 
depression, as there usually is in severe cases of 
facial erysipelas, quinine should be combined with 
the belladonna, giving one-quarter of a grain of the 
extract of belladonna with from two to five grains of 
sulphate of quinia every three or four hours. 

Should we have reason, from the occurrence of 
delirium or the beginning of coma, to suspect that 
emboli are being deposited, we should, without delay, 
resort to the use of carbonate of ammonium, and pro- 
duce full alkalization of the blood as speedily as 
possible. Such are the general principles of the 
systemic management of these cases. 



ERYSIPELAS. 127 

The text-books contain a vast variety of remedies 
to be applied locally. The attempt is made to stop 
its spread by the use of blisters, nitrate of silver, 
tincture of iodine, a saturated solution of the sulphate 
of iron, carbolic acid and a thousand and one other 
remedies. All this is based upon a fallacy. This 
condition of the skin is a symptom of the malady, 
and only a symptom. We cannot prevent or limit 
by such measures the constitutional condition. The 
simplest local application suffices. He had seen 
more good from mercurial ointment very much 
diluted, and from vaseline or lard, than from the 
most elaborate applications. The strength should be 
one drachm of mercurial ointment to the ounce of 
lard or vaseline. If there is reason to fear that the 
disease will exist as an epidemic, we should, of course, 
adopt measures to prevent the diffusion of germs. 



In a clinical case of facial erysipelas, Prof. Da 
Costa stated that in his experience at the Pennsyl- 
vania Hospital, the treatment that had been usually 
followed was the following : Large doses of the 
tincture of the chloride of iron, quinine, during the 
first few days ; and, locally, the use of demulcents 
and the benzoated oxide of zinc ointment, which are 
very grateful to the sufferer. When the patient 



128 THE PKESEtfT TREATMENT OF DISEASE. 

becomes convalescent, the iron should be diminished 
to fifteen drops every four hours, and quinine given 
in tonic doses, about ten grains daily. By the means 
of mild diluents, the action of the kidneys may be 
maintained, the skin kept moist, and the course of 
the disease favorably modified. With good nursing 
and proper care, relapse rarely occurs, except in the 
phlegmonous variety ; but under the iron treatment, 
suppurative inflammation is very seldom observed. 



EXOPHTHALMIC GOITRE. 

In a clinical case of this disease, Prof. Bartholow 
stated that he had effected cures in several cases by 
persistent galvanization of the cervical sympathetic. 
He had repeatedly seen symptoms of a violent char- 
acter disappear under the use of galvanism, the 
positive electrode being applied in the fossa behind 
the angle of the jaw, and the negative on the epi- 
gastrium. A current of from ten to thirty cells is 
used, according to the condition of the patient and 
the amount of reaction. The stabile galvanic current 
is the proper one. The applications should be made 
daily for ten minutes at a time. This will tone up 
the sympathetic, which is the seat of the disorder, 
will moderate the action of the heart, contract the 
dilated vessels and diminish the size of the thyroid. 



EXOPHTHALMIC GOITKE. 129 

He was particular in saying that the constant galvanic 
current will cure uncomplicated cases of exophthal- 
mic goitre, which are purely functional derangements 
of the sympathetic system. In many cases compli- 
cations exist, the most usual being in the heart and 
great vessels. Such lesions, being permanent, cannot 
be removed by such a remedy. 

The fact must not be lost sight of that the treat- 
ment is not directed solely to the ganglia of the sym- 
pathetic, for if one electrode be placed behind the 
angle of the jaw and the other on the epigastrium, 
there are within the circuit not only the cervical 
sympathetic, but the pneumogastric, the descendens 
noni and the cardiac branches of the sympathetic. 

In addition to this, remedies which modify the 
activity of the sympathetic system may be admin- 
istered by the mouth. Digitalis has been much used, 
and has sometimes been of service. Ergot has also 
done good in many of these cases. The two remedies 
may be combined as follows : — 

Ext. ergotse (Squibb's aq. ex.), gr.ij 

Pulv. digitalis, gr.j. M. 

Sig. — Ter die ; 

and locally the ointment of the red iodide of mer- 
cury, rubbed in over the enlarged gland, preferably 



130 THE PRESENT TREATMENT OF DISEASE. 

under the direct rays of the sun. When the neck 
becomes sore, wait until desquamation has taken 
place, then reapply cautiously. 

In another case, he prescribed, in addition to gal- 
vanization, the following combination : — 

9. 

Extracti ergotae, 

Ferri sulphatis, aa gr.xxx 

Strychninse sulph., gr.ss. M. 

Ft. pil. xxx. 
Sig. — One three times a day. 



Dr. Morris Longstreth, in a clinical case of ex- 
ophthalmic goitre, in a young woman who was 
decidedly anaemic, prescribed the following treat- 
ment: Allay irritability of the accelerating appa- 
ratus of heart — a stabile galvanic current. Correct 
anaemia by — 

Digitalis, 3] 

Mangani. sulph. exsiccat, 9j 

Ferri sulph., gr.x. M. 

Ft. pil. x. 
Sig. — One ter die. 



Prof. Da Costa, in a clinical case of this disease, 
insisted on the importance of diet and rest thus : — 
He shall have a very moderate diet, almost ex- 



EXOPHTHALMIC GOITRE. 131 

clusively a milk diet, only very rarely a few oysters. 
He shall have neither tea nor coffee, nor is anything 
stimulating to the circulation to be given. Having 
taken away the irritability of the heart,., he shall be 
allowed a bland diet, nourishing enough, but which 
will not excite the circulation. Secondly, he shall 
rest in bed, the greater part of the day, at least, 
mainly to modify the hypertrophy of the heart, 
rather than for any effect upon that of the thyroid 
gland. Rest is as much a part of the treatment as 
in cases of aneurism. 

To control the circulation, and bring down the force 
and power of the heart, he would order veratrum 
viride, one drop of the fluid extract every three 
hours, diminishing or increasing the dose, according 
to the effect upon the pulse and cardiac beat. In 
addition, partly for its constitutional effect upon the 
heart, and partly for its effect upon the nervous sys- 
tem, he would give him thirty grains of bromide of 
potassium at night. Modify nutrition by withdraw- 
ing everything stimulating, while supplying good 
but not rich blood to the tissues. Keep the circu- 
lation quiet in these cases, and reduction in the 
size of the heart will probably be produced. The 
bromide assists, but this is in addition to its special 
action upon the nervous system. 



132 THE PRESENT TREATMENT OF DISEASE. 

As to local treatment, iodine is not so good as in 
other forms of goitre, but is generally employed. 
Ergot, hypodermically or internally, is also used, 
but in this case is contraindicated by the great 
enlargement of the heart that coexists. He 
would endeavor to shrink the gland and control 
the vascular supply by the daily application 
of ice. 

Nothing can be done for the eyes, for the condition 
is dependent upon the heart. He had found it suit- 
able, where the exophthalmos is very marked, to give 
an occasional purgative, a saline generally. It is 
always followed by better vision, for the trouble 
depends upon the state of distention of the tissues 
forming the cushion, upon which the eye rests, 
pushing the eye forward. This purgative is all the 
more indicated when we have cerebral symptoms 
coexisting. This is always the treatment of ex- 
ophthalmic goitre ; it is the treatment proper for 
a case with enlargement of the heart. Where there 
is marked anaemia, a long course of iron would be 
indicated. Again, there are certain remedies acting 
upon the general system, such as arsenic, or the 
administration of digitalis, or the application of the 
constant current to the neck, which may come into 
play in certain cases. 



EYE, DISEASES OF. 133 

EYE, DISEASES OF. 

For blepharitis marginalis, Dr. L. Webster Fox 
directed the eyes to be bathed twice daily in aqua 
chlorinii, and at the same time ordered the eyes to 
be refracted. The following solution was then given 
preparatory to the testing for glasses : — 

Atropinae sulph., gr.j 

Aquae destillat, f5nj. M. 

Sig. — One drop in each eye, three times daily. 

At the same Hospital he prescribed for a case of 
acute conjunctivitis — 

Acid, borici, gr.xij 

Aquae camphorae, 

Aquae destil., aa f§ij. M. 

Sig. — Eye lotion. 

Or the following : — 

Acid, boric, g r - x y 

Zinci chlorid., gr.iij 

Aquae cam ph., 

Aquae destillat, aa f§ij. M. 

Sig. — Use as lotion for eyes. 

Should this fail, use something stronger, as zinc 
chloride, gr. ij to fgj. In the third stage, where we 
are confronted with granular lids, use the caustic 
copper, in sticks. 



134 THE PRESENT TREATMENT OF DISEASE. 

For chronic conjunctivitis, the following prescrip- 
tion is found very successful at Jefferson Hospital : — 

Zinci chloridi, gr.iv 

Vini opii, f5ij 

Sassafras med. (filtrat.), gr.x 
Aquae camphor., 

Aquae destill., aa f§ij. M. 

Sig. — Drop into the eyes, twice a day, after bathing 
with warm water. 

When the trouble is acute, boric acid, twelve 
grains, is substituted for the zinc chloride. 



To relieve the pain of an eye, due to a stye or 
injury, Dr. Fox, at the Jefferson Hospital, recom- 
mended the following : — 

fy. 

Tinct. opii, f5j 

Tinct. belladonnse, f5j 

Acid, boric, gr.x 

Aquae camph., 

Aquae destill., aa fSj. M. 

Sig. — Saturate a small cloth with the solution and place 
over the eye. 

Prof. William Thomson directed, in a severe case 
of purulent ophthalmia in an infant, that the eyes be 
well washed out every two or three hours with a 



FLOATING KIDNEY. 135 

solution of borax, ten grains to the ounce ; then apply 
one of these collyria : — 

Aluminis, gr.ij 

Aquse, f§j. M. 

Or— 

Argent, nitratis, gr.ij 

Aquae, fBj. M. 

FLOATING KIDNEY. 

In a clinical case of this affection, Prof. Bartholow 
said that medicines directly can do very little, but 
indirectly they can accomplish something in the way 
of relieving symptoms. An abdominal bandage well 
applied would give great comfort. In order to ad- 
just it, the patient is placed recumbent, and then the 
offending kidney is to be gently pressed up into 
position, where it is held by the bandage, drawn 
with considerable firmness, which should be worn 
night and day ; if taken off at night it will undo the 
work of the day. By constant use of the bandage 
for months and years, adhesions that will maintain 
the kidney in place may occur, and he had thus 
succeeded in obtaining such new attachments when 
the bandage was worn for several years. Attention 
to the functions of the abdominal organs is also 



136 THE PRESENT TREATMENT OF DISEASE. 

essential ; flatus must be carefully guarded against 
by cutting off all articles of food that ferment readily 
in the stomach or intestines. This point is one of 
much importance. 

With a view of overcoming this condition of 
abdominal fullness, he would order a drop or two of 
carbolic acid three times daily, and prevent con- 
stipation by aperients occasionally, so that no colonic 
accumulation may press upon the kidney. 



In a clinical case of floating kidney, under care 
of Dr. James C. Wilson,* Physician to the Jefferson 
Medical College Hospital, the following observations 
were made as to the remedial measures indicated : 
The treatment, by a sort of contradiction of terms, is 
more satisfactory than the prognosis, for while you 
cannot relieve the condition, you can do much to 
make it bearable. In the first place, you must make 
your patient understand the nature and character of 
the tumor, in order to relieve his mental symptoms ; 
in the second place, associated causes of ill health 
must be removed. As anaemia and inanition are 
very frequently present, a generous diet and the use 
of iron are indicated. As the subjects of this con- 
dition are frequently overworked as well as underfed, 

* Medical Times. 



GASTRALGIA. 137 

rest and the avoidance of the more toilsome occupa- 
tions are, if possible, to be secured. If the symptoms 
be such as to wear the patient out, and to incapacitate 
him for self-support and enjoyment of life, or if the 
displaced organ be the seat of malignant or suppu- 
rative disease, surgical interference may become 
necessary. In the former case, whether the displaced 
organ, free from disease, should be extirpated — 
nephrectomy — or fixed in the loin — nephrorrhaphy 
— is still an open question in surgery. In the latter 
case, extirpation is the only resource, and nephrec- 
tomy is, even under favorable circumstances, one of 
the most fatal operations of surgery. 



GASTRALGIA. 

In gastralgia Prof. Bartholow has often obtained 
good results from — 

Atropinse sulph., gr.j 

Zinci sulph., 5ss 

Aquae destill., fSj. M. 
Sig. — Three to five drops twice or thrice daily. 



Prof. Da Costa gives the following directions as to 
the treatment of gastric pain or gastralgia: Diet 
of little importance. Stimulus at meals in small 
amounts. Morphia relieves at once, but use it care- 



138 THE PRESENT TREATMENT OF DISEASE, 

fully. 1. Bismuth with a little opium. 2. Nitro- 
muriatic acid, gtt. ij-iij, diluted, or 3. — 

Morph. sulph., g r «A 

Acid, carbolici, gtt.j 

Aq. raenth. pip., ad f5j. M. 

Sig. — Ter die. 

4. Fowler's solution, beginning with gtt. j, and 
increase to gtt. v, ter die. 



GASTRIC CATARRH— GASTRITIS. 

In the treatment of chronic gastritis, Prof. Da 
Costa teaches that the cause should be removed. A 
scanty supply of food. Pepsin at each meal (gr. v). 
Milk, with a little meat, may be taken as food. 
Oxide of silver, gr. J, a dose, will be found of value. 
Bismuth is useful. Avoid tonics, but use the min- 
eral waters to keep portal system drained. 



Prof. Gross gave the following directions for 
making koumiss, which he states is an excellent 
article of diet when the stomach cannot tolerate 
food : — 



M. 
M. 



Grape sugar, 
Water, 


Sss 
fgiv. 


Milk, 
Fleischmann's yeast, 


SB- 



GASTRIC CATARRH GASTRITIS. 139 

Mix the two I^s in a quart bottle, and then fill the 
bottle with milk ; cork securely ; shake ter die, and 
on third day use. A quart may be used in twenty- 
four hours. In catarrhal conditions of the stomach 
it is most agreeable. 



Prof. Bartholow, in a clinical case of gastric 
catarrh, said that such patients are liable to violent 
attacks of palpitation of the heart, due to the reflected 
irritation from a stomach greatly distended by flatus 
and food. In order to improve the condition of the 
stomach, the patient should take Lugol's solution, 
five drops, in sweetened water, before meals. This 
will relieve the pain, and also act favorably upon 
the disturbed condition of the heart. 



In an aggravated clinical case of gastric catarrh, 
with gastralgia, Prof. Da Costa advised the following 
treatment : Diet — milk and soft-boiled eggs, a little 
lime water to be added to the milk. Between meals 
bismuthi subnitras, gr. xv. At night — 

Aloes, gr.J 

Ext. belladonnse, g^ir* M. 

Fiat pil. 

In another case, he directed that the upper bowel 



140 THE PRESENT TREATMENT OF DISEASE. 

be kept unloaded by calomel, gr. i, and sodii bicar- 
bonat., gr. ij, taken every night, and sodii phosphat., 
5j, night and morning. 

In chronic gastric catarrh, he prescribed the fol- 
lowing pill : — 

Argenti nitrat., gr.J 

Ext, belladonna?, g r 'Tg-* M. 

Sig. — Ter die. 

And for accompanying constipation, he prescribed — 

Pulv. ipecac, gr.J 

Pulv. rhei, gr.ij 

Ext. colocynth. comp., gr.j. M. 
Sig. — To be taken at night. 



GASTRIC ULCER. 

In a clinical case of gastric ulcer, Prof. Da Costa 
stated that we are obliged to give the stomach rest, 
and must therefore resort to nutritious enemata, 
except some food of a very simple character, such as 
skimmed milk with lime water, and pieces of ice 
occasionally. Three or four times every day this 
patient had injections of beef tea or milk; not more 
than two ounces at one time, so that it could be 
easily retained, and one egg. The addition of a few 
drops of deodorized tincture of opium was found of 



GASTRIC ULCER. 141 

great assistance in enabling the patient to retain the 
injections. Ergot, made into a solution with glycer- 
ine and water, was given hypodermically, in a dose 
equivalent to five grains of the extract. The effect 
in checking the bleeding was immediate and lasting. 
He could recommend this method of administering 
the remedy, not only in hsematemesis, but also for 
pulmonary hemorrhage, intestinal hemorrhage in 
typhoid, and in diabetes. 

He was inclined, in this case, to use the silver salts, 
giving the oxide, in doses of one-half of a grain. 
After a while, to improve her blood, which is hy- 
dremic, he would give her hypodermic injections 
of iron ; the best preparation for this purpose being 
ammonio-citrate, a crystalline salt, readily soluble 
in water, and giving rise to very little irritation, 
very rarely causing abscess. He had also used 
dialysed iron for this purpose, with excellent results, 
but in some cases it unaccountably causes inflamma- 
tion. Whichever may be adopted or rejected, do not 
overlook the hygienic treatment, as the patient is in 
need of sunshine and fresh air as much as of nourish- 
ing food. 

In a clinical case of gastric ulcer, Prof. Bartholow 
stated that we have in rectal alimentation, especially 



142 THE PRESENT TREATMENT OF DISEASE. 

by the injection of defibrinated beef's blood, an 
excellent and available means of nourishing the 
patient and of securing rest for the stomach. The 
manner of using the blood is to obtain it at the 
butcher's shambles, as soon as it is drawn from 
the animal ; while warm it is whipped with a bundle 
of fine twigs and rapidly strained. About half a 
pint of this defibrinated blood is administered by 
enema, night and morning, if the patient is able to 
retain so much. The remedy is in a form which 
enables it at once to enter the blood and nourish the 
patient. He desired to emphasize this point : where 
a person is suffering with a stomach disorder, and it 
becomes necessary to give the stomach rest, there is 
in defibrinated blood a means of accomplishing this. 
It is a most successful remedy in the treatment of 
gastric ulcer, where it is necessary to give the organ 
absolute rest. In order to allow the ulcer to cicatrize, 
we may feed the patient exclusively by rectal injec- 
tions. Hitherto the ingenuity of physiologists and 
therapeutists has been taxed to the utmost to furnish 
an acceptable method of nourishing such patients, 
but nothing yet has equaled defibrinated blood when 
employed in this way. 

Throughout the course of its administration the 
large bowel should be irrigated once or twice weekly, 



GASTROINTESTINAL CATARRH. 143 

to remove a coating of blood which may adhere to 
the surface of the mucous membrane and interfere 
with further absorption. A large enema of warm 
water may be used for this purpose, but irrigation is 
preferable. In addition to the rectal alimentation, 
he should take no food by the stomach except occa- 
sionally a small quantity of milk and lime water. 
Ho should also take, thrice daily, one drop of a 
combination consisting of equal parts of Lugol's 
solution of iodine and carbolic acid. The ordinary 
method of administration would be to give the car- 
bolic acid after eating and the iodine before. 



GASTRO-INTESTINAL CATARRH. 

A child with catarrh of the intestines was given, 
by Prof. Bartholow — 

Bismuth, subcarb., gr.v 

Creasoti, gtt.J. 

Ft. emulsio. 
Sig. — Every three hours. 

In a case of gastro-intestinal catarrh, secondary to 
a condition of cirrhosis of liver, he prescribed — 

Creasoti, gtt.j 

Bismuthi subnitrat., gr.xv 

Glycerini, f5ss. M. 

. Sig. — Ter die, diluted, and milk diet. 



144 THE PEESENT TREATMENT OF DISEASE. 

To check the hyperplasia of the connective tissue — 

9. 

Ol. phosphorati, gtt. i-ij 

Mucilaginis, q.s. M. 

Sig. — To be given after the stomach has regained its 
former condition. 



In a case of gastro-intestinal catarrh,* causing 
enlargement of the liver, at the Pennsylvania Hos- 
pital, Prof. Da Costa placed the patient at first upon 
small doses of calomel with bicarbonate of sodium, 
and a milk diet. This was followed by one drachm 
of the phosphate of sodium (in warm water) thrice 
daily, on an empty stomach. It is better borne when 
given in warm water. It will sometimes act as a 
laxative, and if it does so excessively, the dose must 
be reduced. 

In addition to this internal medication, he recom- 
mended painting over the surface of the liver with 
tincture of iodine diluted to one-half its strength. 
The girl's diet, so far, had consisted of milk and 
soups ; this had been well retained save during the 
last twenty-four hours, when she vomited. She had 
had no solid food. She was directed to take a quart 
to three pints of skim milk with lime water (in the 
proportion of half an ounce of lime water to four 

* Therapeutic Gazette. 



GENITOURINARY AFFECTIONS. 145 

ounces of milk), and also to have the soup and 
a few stewed oysters occasionally. All starchy arti- 
cles must be rigidly excluded from the dietary. As 
she improves, she will be allowed to have under- 
done meat ; but it will be a long time before she can 
be allowed to use a mixed diet, and particularly any 
articles containing starch or sugar. 



GENITO-URINARY AFFECTIONS. 

For an irritable or inflamed condition of the genito- 
urinary tract, Prof. Pancoast habitually uses the fol- 
lowing prescription : — 



Buchu, 


Sxviij 


Uvse ursi, 


Sviij 


Aquae bullientis, 


Cong.j. M. 


Boil to two-and-a-half pints, and add 




Alcohol, 


Oiss 


Olei cubebae, 


fSj 


Olei juniperi, 


fSss 


Spirit, setheris nitrosi, 


fgiv. M. 


This may be administered in doses of a 


dessertspoonful to 


a tablespoonful three times daily. 





A young man who had for several years practiced 
masturbation applied at the clinic for relief, as he 



10 



146 THE PRESENT TREATMENT OF DISEASE. 

was suffering from a morbid sensibility of the urethra, 
with constant sticky discharge from that canal. He 
was given, by Prof. Gross — 

Potass, broraid., 5j 

Sodii bicarb., gr.xv 

Inf. digitalis, fgss 

Atropine sulph., g r ^V M. 
SiG. — At bedtime. 

To relieve the pain and irritability of the bladder 
in a clinical case of inflammation of that organ, he 
ordered tinctura opii camphorata f5j administered 
three times a day. 

For an irritable condition of the neck of the 
bladder, causing frequent micturition, a favorite as 
well as efficacious prescription is the following, of 
Prof. Pancoast: — 

Lupulinse, 5j 

Tinct. opii camph., f5j 

Infus. buchu, fSiij 

Syr. orgeat, f§ij. M. 

SiG. — A teaspoonful to a dessertspoonful, in water, four 
times a day. 

To render the above still more useful, an opium 
suppository, gr. ss, may be placed in the rectum 
morning and evening. 



GENTTOUKINARY AFFECTIONS. 147 

For a case of renal inadequacy and gastric catarrh, 
Prof. Da Costa ordered a strict diet, argent, oxid., 
gr. i, and ext. belladonnse, gr. A, ter die, a saline 
for the bowels and for the kidneys : — 

Potass, acet., gr.xx 

Tinct. zingib., gtt.xx 

Elixir, simp., 

Aqua?, aa q.s. ad f5ij. M. 

Sig. — Every third hour, well diluted. 

At a recent clinic of Prof. Da Costa's, a woman 
presented herself, complaining merely of indigestion, 
The case being fully developed, a diagnosis of renal 
inadequacy was made, and the patient put upon 
citrate of caffeine, gr. ij, ter die; the dose to be 
increased to gr. v ter die. 



In chronic catarrh of the pelvis of the kidneys, 
the ureters and the bladder, also in simple irri- 
tability of the bladder without apparent cause, 
especially in women, Prof. Bartholow says : Tinct. 
cantharidis, gtt, x to xx quater die, kept up per- 
sistently, is often signally beneficial. 

In chronic catarrh of the bladder, he considers 
eucalyptol as one of the most effective remedies 
that can be employed. 



148 THE PRESENT TREATMENT OF DISEASE. 

GENITO-URINARY ORGANS (FEMALE), DISEASES OF. 

Prof. Parvin placed a woman with uterine fibroid 
upon the following : — 

3*. 

Ergotin., gr.j 

Ferri sulph. exsic, gr.j. M. 

Sig. — Ter die. Persistently used. 

For the accompanying hemorrhages a tampon 
saturated with tinct. iodine or Monsel's solution. 



He considers the best treatment of pruritus pudendi 
to be very hot water, freely applied on cloths. 



To wash out the vagina during pregnancy, he 
recommends the use of a solution of borate of soda, 
5] to Oj. 

Prof. Parvin exhibited, at his clinic, a woman 
successfully treated for vaginismus with — 

Cocainae hydrochlor., gr.j 

Olei theobrom., gr.xxx. 

Fiat suppos. vaginal, j. 
Sig. — Insert one every night, followed by a glass dilator 

in one hour. 



Prof. Parvin says that varicose veins of the vulva 
are relieved by injecting under them some alcohol, 



GENITO-URINARY ORGANS, AFFECTIONS OF. 149 

which, by inflammatory changes, obstructs the flow 
of blood into said vessels. However, he says that 
moderate bandaging is the best treatment. 



Instead of the ordinary iodine solutions for appli- 
cation to the cavities of the uterus and cervix, Prof. 
Parvin now uses these preparations in this manner : 
The first solution is applied by means of a cotton- 
wrapped probe, then immediately the second is 
applied with a different cotton-wrapped probe. The 
acid uniting with the potassium, the iodine is set free 
in the form in which it can accomplish the most 
good, i.e., in the nascent state : — 

No. 1. 
3$, 



Potass, iodidi, 


5j, gr.xv 


Potass, iodatis, 


gr.x 


Aquae, 


fSj. M. 


No. 2. 




3, 




Acid, citric, 


5j, gr.xv 


Aquae, 


fSj. M. 



For the treatment of a clinical case of vaginitis, 
Prof. Parvin recommended, first, the use of simple 
measures and injections of warm borax water, re- 
peated three, four, or five times a day. This will 
prove very soothing also to the external inflamma- 



150 THE PRESENT TREATMENT OF DISEASE. 

tion. If not sufficient, he would order suppositories 
containing the following : — 

Iodoforrai, gr.v 
Ex. belladonnae, 

Morphia? sulph., aa gr.ss 

Olei theobromae., q.s. M. 

Sio. — One of these to be introduced into the vagina 
every night. 

If this does not cure the vaginitis, the vagina will 
be penciled with a solution of nitrate of silver. In 
doing this, a Siins's speculum, with an " elevator " to 
lift up the anterior walls of the vagina, should be 
used. Then the mucous membrane should be 
thoroughly painted with a solution of five to ten 
grains of nitrate of silver to the ounce. For the 
external inflammation, a weak solution of corrosive 
sublimate (1-4000), carbolic acid, hydrocyanic acid, 
or chloral in solution might be employed. As a 
rule, ointments are not used to the external genital 
organs, especially if the inflammation has extended 
to the sebaceous follicles. Ointments under such 
circumstances, even if they contain suitable remedies, 
will usually be found injurious, while, on the other 
hand, the use of an alkaline wash will often accom- 
plish much good, for the alkali dissolves the accumu- 
lated sebaceous secretion. A solution of carbolate 



GOITRE. 151 

of zinc, or of subacetate of lead, often proves useful 
in vulval pruritus. Hot water, as a local application, 
often proves valuable in a pure pruritus — that is, 
where there is no inflammation causing the intense 
itching. 



GOITRE. 

In a case of this affection, Prof. Bartholow said 
that the ointment of the red oxide of mercury will 
cure any case of goitre in which the gland has not 
undergone either cystic or calcareous degeneration. 
It .is also very valuable in chronic enlargements of 
the spleen. 

In a clinical case of goitre, Prof. Gross stated that 
there are several things which might be done for 
this disease. Sorbefacient remedies are often service- 
able. A very common prescription with him is the 
following : — 

Unguent, hydrarg. biniodid., 5j 

Camphorse, 5j 

Cosmoline, 5j. M. 

Prof. Da Costa treated a case of goitre with syrup 
ferri iodidi, gtt. xx, ter die, and local applications of 
the official ointment of iodide of mercury. Another 



152 THE PKESENT TREATMENT OF DISEASE. 

case of the same was given tinct. aconite, gtt. ij, ter 
die, with ice locally. 

He directed the patient, each morning, to take a 
piece the size of a marrow-fat pea, and to stand so 
that the direct rays of the sun may fall upon the 
goitre while the ointment is rubbed in. The appli- 
cation may be repeated at night. He would also 
give her five drops of Lugol's solution, to be taken 
largely diluted, after each meal. In place of this, 
muriate of ammonia might be added, in twenty- 
grain doses, three or four times in the twenty-four 
hours ; and by gradually increasing the dose, some 
decrease in the size of the growth might confidently 
be looked for. Under these remedies, it is fre- 
quently found that the tumor almost entirely dis- 
appears. 

This case might be treated by parenchymatous 
injections; iodine in various forms, or ergotin, or 
Fowler's solution, might be thrown into the tumor ; 
but he did not think any great benefit would result. 
These interstitial injections have no special advantage 
to compensate for the danger of the occurrence of 
inflammation, necrosis and abscess, which may en- 
danger the life of a patient. 



GOITRE, EXOPHTHALMIC. See Exophthalmic Goitre. 



GONORRHOEA. 153 

GONORRHOEA. 

In the early treatment of gonorrhoea, Prof. Gross 
condemns the use of injections. His plan is as 
follows : If possible, put the patient to bed ; give 
him at the outset a purge, by administering Epsom 
and Rochelle salts, each Sij, in lemon syrup. Allow 
no meat or any stimulating articles of diet, etc. 
Malt liquors do more harm than alcoholic, so inter- 
dict both. He should not take tea or coffee, but 
milk, eggs and some oysters, etc. Three times daily 
he is to hold the penis in a cup of hot water — quite 
hot. Keep the organ there for five minutes at a 
time, then wipe it gently each time. 

The internal treatment will be by the " antimonial 
and saline mixture : " — 



SlG.- 



Antimonii et potassii tartrat., 


g r -iV 


Magnesii sulphatis, 


3ij 


Morphinse sulphatis, 


gr-iV 


Tinct. aconiti radicis, 


gtt-j 


Liquor, potassii citrat., 


f5ss 


Olei limonis, 


gtt.ss 


Elixir, siraplicis, 


fSss. 


-Ter die. 





M. 



By this treatment the urine will be rendered bland 
and unirritating. Should the urine persist in " scald- 
ing/' then add to the above prescription gtt. x tinct. 



154 THE PRESENT TREATMENT OF DISEASE. 

cannabis indicse. To prevent or cure chordee, order 
at night a suppository of — 

Extract, opii, 

Camphorse, aa g r «iij« 

In the course of four or five days the discharge 

from the urethra will look more like laudable pus ; 

then order an injection : — 

Hydrargyri chloridi corrosivi, gr.ij 

Aquae destillat., Oj. M. 

Sig. — With a syringe that holds an ounce, inject into 
the urethra — having first " flushed" the canal several 
times by voiding urine — and retain the fluid for five 
minutes. 

Internally, a useful combination is that used at 
the out-door department at the Hospital, and con- 
sisting of — 

Cubebae, §ij 

Alum, pulv., 5j. M. 

Sig. — Of this take a heaping teaspoonful in a tumbler 
of water ter die ; the dose to be increased. 

Should the discharge per urethram still persist, 
use an injection of — 

Liquor, plumbi subacetatis, f5j 

Aquse, fSx. M. 





ijunt urixv-tii-r. 


m»-« 


At 


Or- 








9- 


Plumbi acetatis, 


gr-ij 






Zinci sulphat., 
Aquae, 


gr.iij 

fSj. 


M. 


Or- 








I$5. 


Acidi tannici, 
Aquae, 


gr-lj 

fSj. 


M. 



According to Prof. Bartholow, the following, in 
gonorrhoea, after the acute stage, is efficacious : — 

Zinci sulphat., 

Plumbi acetat., aa gr.viij 

Amnaonii chlorid., 

Aluminis, aa gr.iv 

Aquae rosae, foj. M. 

Sig. — As an injection. 

He also considered subnitrate of bismuth, mixed 
with glycerine, as thick as can be used in a syringe, 
a capital injection for gonorrhoea. 



From a lecture recently given by Dr. Joseph 
Hearn, at the Jefferson Medical College Hospital, 
the following note was taken regarding the treatment 
of gonorrhoea : — 



156 THE PRESENT TREATMENT OF DISEASE. 

For first stages, a mild diet ; avoid excesses espe- 
cially of drink; locally, hot- water baths for penis, 
also hot- water injections, together with the antimo- 
nial saline mixture, or — 

9. 

Potas. citrat., gr.xx 

Sodii bromid., gr.xl. M. 

Sig. — Ter die. 

In second stage, resort to copaiba, cubebs, and 
especially oil of sandal wood, was recommended. 
Copaiba could be given in a mixture of acacia syrup 
and water, together with citrate of potassium, or in 
syr. sarsaparillse with cubebs. 

In third stage, use one of the following as injec- 
tions : — 



9. 




Plumbi acet., 


gr-ij 


Zinci sulph., 


g r J 


Aquae, 


fgj. 


Sig. — As an injection. 




3. 




Hydrarg. chlor. corros., 


g r -j 


Liq. caleis, 


as 


Aquae, 


fgxij. 


Sig. — As an injection. 





M. 



M. 



If discharge persists, use steel bougies three times 
a week. 



GONORRHCEA. 157 

In a clinical case of gonorrhceal rheumatism, Dr. 
Morris Longstreth prescribed quinise sulphas (gr. 
iv) and tinctura ferri chloridi (gtt. xx), three times 
a day. The joint was painted with tincture of 
iodine. Castor oil was given for constipation. 
The tincture of the chloride of iron was stopped, 
as it apparently disagreed with his stomach. In 
these cases the digestive functions should be en- 
couraged. He therefore substituted proto-chloride 
of iron (gr. i ter die), in syrup and water. The 
joint still continued to be painted with iodine. 

Gonorrhceal rheumatism is less rapidly amenable 
to remedies than acute articular rheumatism, at the 
same time not attended with any of its dangers. 
We do not have to combat the attacks of endo- and 
peri-carditis, or of pleurisy, which occur so frequently 
in the latter disease. Theoretically, many would 
have it that the disease is a local one, and confine 
their attention to the joints and possibly the urethra. 
But the patient may need at least as much attention 
for his general condition as his gonorrhceal rheu- 
matism. 

First, however, as to the joints. The remedies 
are to be proportioned to activity of the symptoms. 
Rarely will you see cases requiring leeching, though 
they do occur ; lead water and laudanum are more 



158 THE PRESENT TREATMENT OF DISEASE. 

frequently required ; iodine, or perhaps mercurials, 
will generally be found of most advantage. Rest is 
absolutely required in all stages, but the joint should 
not be immovably fixed, lest it become anchylosed. 
If the effusion be delayed in its absorption, pressure 
by bandaging or strapping will be applied. 

The general treatment needs attention in two 
directions ; the patients may be simply broken down, 
as is so frequent among hospital cases, requiring food 
and tonics; or, on the other hand, more rarely, 
where the pysemic symptoms are marked, the use 
of quinine and iron, to directly influence the febrile 
condition, is indicated. 

It usually happens that you will see the patient 
for the first time when the gonorrhoeal disease is 
subsiding or gone ; or, perhaps, arrive at the diag- 
nosis at a period when it requires no attention, for, 
especially among hospital cases, no allusion will be 
made to it or its existence positively denied. All 
measures directed to the cure of the gonorrhoea 
should be very cautiously used, lest, so far as con- 
cerns the general condition of the patient or the 
articular affection, they do more harm than good. 



Prof. Da Costa, in a clinical case of gonorrhoeal 
rheumatism, placed the patient upon chlorate of 



HEMATURIA. 159 

potassium, with a view of modifying the state of the 
diseased mucous membrane, and, to some extent, the 
blood; and a certain amount of chlorate of potas- 
sium (gr. v solution) was employed locally as a 
urethral injection. No other local treatment was 
adopted. This treatment would be continued until 
the gonorrhoea is entirely stopped, when the chlorate 
of potassium will be suspended, and tinctura ferri 
chloridi (gtt. xx), four times daily, and ten grains of 
quinia daily, given, and also good food. 



GOUT. 

Prof. Da Costa teaches that arsenic, in small doses, 
is very useful in chronic gout. Prof. Bartholow 
considers salicylate of lithium a useful remedy. It 
does not derange the stomach, and is pleasant to 
take. Dose, gr. ij-x, or even gr. xx. 



H/EMATURIA. 

Prof. Da Costa gives the following directions for 
the treatment of hematuria : Treat the cause as well 
as the symptoms, though the treatment of both is 
generally the same. 1. Gallic acid, in doses of gr. 
x-xx, repeated every hour or two. 2. Sulphuric 
acid, alone or with gallic acid, unless contraindicated 
by scarlet fever, etc. 3. Fluid extract of ergot, gtt. 



160 THE PKESENT TKEATMENT OF DISEASE. 

xx, increased to f5j. All three o£ the above are 
reliable remedies. 

He mentioned the diagnostic point noticed by Dr. 
Morris Longstreth, that in hsematuria the blood 
corpuscles are round and of normal appearance 
when from the kidney, and are small, shriveled 
and broken up when from the bladder. 



Prof. Bartholow states that in renal hemorrhage, 
the following is generally very effective : — 

Extract, ergotse fluid., 

Tinct. krameriae, aa f§ij. M. 

SiG. — f5j every hour or two. 



HEMOPTYSIS. See Hemorrhage. 



HAY FEVER. 

In a paper read before the College of Phy- 
sicians of Philadelphia, Prof. Da Costa gave the 
particulars of several cases of rose-cold, hay fever 
and influenza treated by the local application of a 
four per cent, solution of cocaine. He stated that 
the manner of employing the cocaine is not without 
importance. It may be used with a small atomizer 
as a spray ; but the readiest means is to inject from 
five to eight drops up each nostril, the head being 



HEADACHE. 161 

thrown backward ; in some persons once, in most 
twice daily, will be found sufficient. It will be 
necessary to instruct patients not to irritate the 
membrane by rubbing it needlessly with the glass 
tube, or pushing this up too far. 

Its mode of action in hay fever is partly by the 
local insensibility it produces, partly by the con- 
tractions of the capillaries that result. The effects 
are thus chiefly local. It will not arrest the bron- 
chial catarrh or the asthma, which attend some 
cases ; yet it is astonishing how it seems to lessen 
the tendency to these complications when early 
applied, and before they have gotten much headway. 
The remedy is not, strictly speaking, curative ; but it 
gives great comfort, converts bad into light cases, 
enables those to stay at their homes who otherwise 
are obliged to flee to hay fever resorts, and relieves 
much suffering and distress. In no case of rose- 
cold or hay fever ought cocaine to be left untried. 



HEADACHE. 

In a clinical case of the form of headache known 
as migraine, or hemicrania, Prof. Bartholow said that 
we must commence by altering the manner of life. 
The patient must discontinue tobacco and coffee, and 
by correcting indigestion stop the external source of 



11 



162 THE PRESENT TREATMENT OF DISEASE. 

irritation which constantly keeps the centre in a state 
of irritability. Instead of coffee and tea let him 
use milk ; no fried food ; and as he has found that 
eating pie at night always brings on an attack the 
next morning, let him discontinue the pastry, and 
eat a plain but well-cooked and readily digested diet. 

Among the remedies for headache may be men- 
tioned bromide of potassium, guarana and paullinia, 
which is closely allied to the former. The bromide 
will abort these paroxysms, by allaying the irrita- 
bility of both the fifth and pneumogastric nucleus. 
But to cure the disease permanently, we must go to 
the source of the evil, and cure the catarrh of the 
stomach, by administering Fowler's solution, properly 
diluted, at meal times. The dose of bromide must be 
given early, before the attacks come on. He may 
commence with two drops of Fowler's solution, and 
keep this up for a month before reducing it to one 
drop. 

Should the headache appear in spite of these 
precautions, it may be that half a drachm of the 
fluid extract of guarana will afford him relief. 



In hemicrania, in a woman who was also troubled 
with acid dyspepsia, Prof. Da Costa prescribed 
bromide of nickel, as follows : — 



HEART, DISEASES OF. 163 

Niccoli broraid., 3ij 

Ol. gaultheriae, gtt.vj 

Syrup, tolu, fSss 

Aquse, q.s. ad fSij. M. 

Sig. — Teaspoonful ter die. 

After a while the dose of the bromide is to be 
doubled. At night aloin, gr. tV, is to be taken, 
followed in the morning by 5j of potassii et sodii 
tartras. 



HEART, DISEASES OF. 

In functional disorders of the heart, Prof. Da 
Costa speaks highly of three agents, viz. : — 

1. Digitalis, which is most excellent. 

2. Belladonna, especially useful when there is 
irregularity of action and cardiac pain. It may be 
combined with digitalis. 

3. Strychnine is efficacious when we have a de- 
pressed condition of the nervous system. 



Dr. Morris Longstreth exhibited a patient at the 
Pennsylvania Hospital suffering with mitral and 
aortic insufficiency. Pulse very weak and slow, 
between thirty and forty per minute, headache and 
sense of oppression, cold extremities. Under the 
use of digitalis but little was accomplished ; then 



164 THE PRESENT TREATMENT OF DISEASE. 

ammonia in large doses was given, in addition, and 
a very great amelioration followed, the pulse became 
more rapid and stronger, the headache and oppression 
disappeared. 

There was recently a very complicated clinical 
case of heart trouble under Prof. Da Costa's care. 
A young man, set. eighteen, had cardiac hypertrophy 
with dilatation, mitral stenosis and regurgitation ; 
also pericardial adhesions. He was directed to 
take — 

Tinct. digitalis, gtt.x 

Tinct. cannabis ind., gtt.iij 

Tinct. cinchon. comp., f5j. M. 

Sig. — Ter die. 

In addition, an occasional dose of Rochelle salt. 
Meat diet. 

For a woman with the double cardiac lesion of 
mitral and aortic stenosis, he gave — 

Tinct. digitalis, gtt.x 

Tinct. cinchonse comp., f5j. M. 

Sig. — Ter die. 



A man, sixty-three years old, suffering from mitral 
stenosis with hypertrophy, and in whom atheroma- 
tous degeneration of the blood vessels was present, 



HEART, DISEASES OF. 165 

was given, by Prof. Da Costa, fluid ext. of conval- 
laria, gtt. viij ter die, to make the heart beat more 
regularly ; Fowler's solution for the atheroma. 

He advised, in a case of mitral stenosis, with some 
roughening of aortic opening and resulting cardiac 
asthma : — 

Tinct. digitalis, gtt.x 

Tinct. belladonnse, gtt.ij 

Tinct. cinchonse comp., £5j. M. 

Sig. — To be taken ter die. 

And for the asthma one drop of the centesimal 

solution of nitro-glycerine at night, to be increased 

to three drops if necessary. 



In a clinical case, Prof. Bartholow gave convalla- 
ria infusion (a tablespoonful twice a day) for mitral 
lesion, preferring it to digitalis. 



Dr. O. P. Rex, Physician to the Jefferson Medical 
College Hospital, prescribed for a man with a mitral 
regurgitant murmur, the following : — 

Pulv. digitalis, gr.£ 

Extract, belladonnse, g r «rV 

Extract, gentianse, q.s. M. 

Fiat pil. 
Sig. — One ter die. 



166 THE PKESENT TREATMENT OF DISEASE. 

In a man set. sixty, suffering from great dyspnoea 
and palpitation consequent upon cardiac hypertrophy 
with aortic stenosis, Prof. Da Costa advised — 

Tinct. veratri viridis, gtt.iij 

Syrup zingiberis, f5j 

Aquae, fgj. M. 

SiG. — f5ij to be taken until palpitation is overcome; 
then discontinue its use. 



At the clinic, Prof. Bartholow gave nitro-glycerine 
to a patient with a mitral lesion causing pulmonic 
and renal congestion, albuminuria and general 
oedema. He thinks it the best remedy we have for 
congestion of the kidneys, and valuable to take work 
off the heart, by lowering the tension. It does not 
interfere with nutrition like digitalis. One drop of 
a one per cent, solution, slowly increased to flushing 
of the face, is the dose. 

He speaks very favorably of the use of nitro- 
glycerine persistently in the treatment of fatty 
heart. It takes the strain off the weakened organ, 
and allows it to gain strength while its work is 
lessened. 



A man with hypertrophy of heart and aortic 
dilatation, upon whose chest could very plainly be 



HEAKT, DISEASES OF. 167 



noticed the systolic dimpling, was given, by Prof. Da 
Costa, quebracho, gtt. xx, bis die, and potassium 
iodide, gr. x, ter die. * 

In the case of a much-afflicted man having mitral 
regurgitation, fibroid liver and kidneys, with result- 
ing ascites and oedema of the legs, Prof. Bartholow 
ordered pulvis jalapse comp., for the latter trouble ; 
for the digestion and liver, acid, nitric, dil., gtt. x, ter 
die ; for the fibroid condition, after the other symp- 
toms were modified — 

**•■ ... . 

Hydrarg. chloridi corrosivi, £ y -tu 

Auri et sodii chloridi, gr-rV M. 

Sig. — Ter die. 

He prescribed for a boy with a very tumultuously 
acting heart, a mitral regurgitant murmur and 
anaemia, this pill, to be taken morning and even- 



g ; — 






3- 






Quininse sulph., 




gr-ij 


Pulv. digitalis, 






Ferri sulph., 


aa 


g r -j 


Pulv. opii, 




g r -To- 


Ft. pil. 







M. 



Treatment of endocarditis (Prof. Bartholow) : Keep 
heart at rest by ice and digitalis : — 



168 THE PRESENT TREATMENT OF DISEASE. 

Infus. digitalis, f§ss-Sj. 

SiG. — Every four hours. 

Fly blister to axillary region. 
In incipient stage, he advises — 

3, 

Morph. sulphat., gr.J 

Quininse sulph., g r « x - M. 

SiG. — Every four hours, for one day. 

In a clinical case of this disease, with mitral lesion 
and albuminuria, Prof. Bartholow said that the 
problem in this case is how to bring about com- 
pensation, both for the heart lesion and for the loss 
of albumen. In order to make up for this defective 
valve, effort should be made to bring about com- 
pensating hypertrophy of the heart, so that the con- 
gestion of the lungs, liver, kidneys, etc., may be 
obviated. The blood pressure should be increased, 
and the quality of the blood improved; but this 
cannot occur as long as this state of the kidneys and 
albuminuria continues. We can, however, enable 
the heart to contract more energetically, and by 
proper regimen relieve this patient to a large degree. 
The patient needs rest and good diet. She is, unfor- 
tunately, a working woman, and cannot obtain proper 
food, and, doubtless, has no time for rest. 



HEAET, DISEASES OF. 169 

Infusi digitalis, fBss. 

As a dose, twice a day. 

She shall also have Basham's mixture, which is 
one of the best combinations in this disease; the 
iron is required on account of her anaemic condition. 



In the case of a patient suffering from acute 
rheumatic endocarditis* Prof. Da Costa said that 
when referring to the use of salicylates in this 
affection, he had called attention to the absolute 
uselessness of salicylates in preventing cardiac com- 
plications. He fully concurred in the estimate of 
the value of salicylic acid or its salts in removing 
the symptoms of rheumatism, the pain and joint 
affection ; but he would say that they are useless in 
preventing the occurrence of heart lesions. 

In regard to the alkaline treatment, when, in a 
case of rheumatism, you detect a commencing cardiac 
inflammation, give alkalies, not only for their actual 
effect, but also to prevent the occurrence of per- 
sistent heart complications. Give them in full doses. 
The object is to saturate rapidly the system and 
defibrinate the blood, and, if possible, prevent de- 
posits upon the valves. We also aim to keep up the 

* Medical Times, May 15th, 1886. 



170 THE PRESENT TREATMENT OF DISEASE. 

secretions, and therefore give the alkali in combina- 
tion with neutral mixture, so as to keep up the action 
of the kidneys. Alkalies, by altering the crasis of 
the blood and acting as depuratives, are the most 
valuable agents we possess in the treatment of in- 
flammations complicating acute rheumatism, and 
especially for the cardiac complications. 

In considering the question of further treatment, 
he would now give ten grains of iodide of potassium 
three times a day, while diminishing the alkali still 
more, — to two drachms of bicarbonate of potassium 
three times a day. The patient should be well 
nourished, but without meat or much nitrogenized 
food. Starchy food, bread and vegetables, and a 
little milk, should constitute, in the main, his dietary. 
Quinine should be continued, eight grains daily, 
simply as a general tonic and with a view to the pre- 
vention of a relapse. (See Rheumatism.) 



For a case of acute (dry) pericarditis, Prof. Da 
Costa prescribed a few small blisters over the apex 
of the heart, and — 

• v- 

Potassii iodidi, gr.iij 

Potassii ace tat., gr.x 

Syr. zingiberis, 

Aquae, aa f5ij. M. 

Sig. — Ter die. 



HEART, DISEASES OF. 171 

He treated a boy, set. twelve, having pericarditis 
with effusion, following a very severe attack of 
chorea, as follows : Potassium acetate, 5ss every 
two hours ; tinct. digitalis, gtt. v every four hours ; 
whiskey, fgij per diem ; to insure quiet and sleep, 
a little paregoric at bedtime. Do not interfere 
too actively with the bowels ; the quieter in every 
respect the patient can be kept, the better. Do not 
allow him to get out of bed under any circumstances 
as long as any effusion is present. 



Prof. Da Costa treated successfully a case of 
irregularly acting heart, first sound divided, pulse 
fifty per minute and weak, with tinct, digitalis, gtt. 
x, quater die. 

At a meeting of the College of Physicians of 
Philadelphia, Prof. Da Costa called attention to the 
hypodermic use of cocaine in cases of cardiac failure 
and weak heart. He had found that doses of one- 
third to two-thirds of a grain strengthened the 
cardiac systole, and, as shown by the sphygmograph, 
the pulse became fuller, stronger, and a little slower. 
Given in this way it was observed that the pupils 
became dilated, but the effect upon sensibility of the 
mucous membranes was only slight, and not com- 



172 THE PRESENT TREATMENT OF DISEASE. 

parable to that following its local employment. 
Injected into the skin it produced a wheal which was 
insensible, but thrown under the skin no local anaes- 
thesia was produced. 

In a clinical case of irritable heart, Prof. Bar- 
tholow prescribed the one per cent, solution of 
nitro-glycerine, beginning with one drop, and this 
dose has been gradually increased until he now takes 
four drops every four hours. This produces charac- 
teristic physiological symptoms. Its effect has been 
to quiet the tumultuous heart, to reduce the number 
of beats to about the normal, and to give them their 
proper force. In order to give permanent relief, it 
is necessary to tone up the forces of the body, to 
restore digestion and improve nutrition, and especially 
the nutrition of the nervous centres, by the use of 
those agents which promote digestion — by a com- 
bination of mineral acids with digestives. He would 
give a teaspoonful of Scheffer's solution of pepsin and 
five drops of diluted muriatic acid, taken directly 
after meals. Something is required to remove the ex- 
cessive mobility of the nervous centres. The remedy 
best adapted to accomplish this, under the present 
circumstances, is the arseniate of iron. This we com- 
bine with strychnine as a tonic for the nerve centres. 



HEART, DISEASES OF. 173 

In a clinical case of irritable heart, associated 
with anaemia and digestive derangements, Prof. 
Bartholow said : It is idle to try to relieve this con- 
dition of the nervous system, unless we supply it 
with good blood ; it cannot be done with drugs alone. 
We will commence by giving this woman ten drops 
of dilute nitric acid thrice daily ; in a little while we 
will order her a more generous diet, prescribing 
especially milk and eggs ; interdicting stale bread (of 
which she eats a great deal), and coca shells (which 
she drinks), because she cannot digest the fats. This 
I know, because the eructations or regurgitations 
are of an offensive acid character ; butyric acid is 
set free. 

We must also leave out starchy, saccharine, and 
all fermenting foods. Nutrition must be forced ; she 
should have milk every three hours, eggs daily, and 
meat at every meal ; and of meat she should have 
fresh beef, game and poultry (but not veal or duck) ; 
fresh fish, no salt meat or salt fish of any kind. 
She should eat but little bread, substituting for it 
such vegetables as celery, lettuce, or spinach, those 
that are free from sugar or starch. She may eat 
lettuce, in the English fashion — that is, to take out 
the centre leaves and dip them in salt. If the 
patient can have cod-liver oil, without its producing 



174 THE PRESENT TREATMENT OF DISEASE, 

acid digestion, it should be given in doses of one 
drachm in half an ounce of whiskey thrice daily. 
A person of fifty years of age, who has led a tem- 
perate life, can take a little whiskey with advantage, 
but it will do no good to one who has been a toper. 
It is quickly oxidized, and it helps primary assimila- 
tion. Exercise should be enjoined just at the end of 
digestion, when the food is ready to be assimilated 
and requires an abundance of oxygen to complete 
the metamorphosis. 

In a case of excessive irritability of the heart, in 
which the pulsations numbered one hundred and 
eighty per minute, Prof. Da Costa prescribed — 

Digitalis, gr.j 

Extract, belladonnae, g r -i-V* M. 

Sig. — One pill, ter die. 

In one of his clinical lectures at the Pennsyl- 
vania Hospital, he recommended the hypodermic 
employment of digitalis, when the indication was 
to revive a flagging heart. He prefers the fluid 
extract diluted with water, two drops being equiv- 
alent to about fifteen minims of the tincture, 
the injection being repeated as often as necessity 
required it. 



HEART, DISEASES OF. 175 

In an interesting clinical case of slow heart, with 
increased blood pressure and increased vascular ten- 
sion, Prof. Da Costa said he had prescribed iron, in 
tonic doses, and for a few days strychnia, and also 
extract of belladonna, in i-grain doses at night. 
We ought to be able to quicken this heart by 
remedies which will equalize the blood pressure 
by controlling the powerful impulse, and the remedy 
most likely to effect this is veratrum viride. But 
in view of the irregularity, we should keep up 
the small amount of belladonna at night. He 
should therefore take two drops of fluid extract 
of veratrum viride three times a day ; and even if 
we fail in remedying the probable cause of the 
altered frequency, we shall improve the abnormal 
forcible action. For the improvement of his blood 
and general nutrition, he may continue taking 
twenty drops of the tincture of the chloride of 
iron after each meal. He should have nourishing 
food, and have the secretions carefully looked 
after. 

The dose of veratrum viride was afterward in- 
creased, but as it apparently had no decided influence 
upon the heart, he was ordered two drops of tincture 
of aconite three times daily. The heart's action, on 
the whole, was softer and more regular, but not much 



176 THE PRESENT TREATMENT OF DISEASE. 

increased in frequency, and for a few days before 
leaving the Hospital for England, it ranged from 
forty-eight to fifty-two per minute. 



In a clinical case of heart disease, with musical 
murmur, Prof. Da Costa said that the treatment 
would depend very much upon the condition of the 
walls of the heart associated with the musical mur- 
mur. In this case there was a moderate amount of 
dilatation, with a slight increase of muscular structure. 
The action of the heart, on the whole, was feeble, 
and even struggling, which accounted for the oppres- 
sion in breathing. The pulse had been singularly 
irregular. By paying attention to this state of the 
cardiac muscle, which, after all, is the part that 
requires attention rather than the valve itself, much 
relief can be afforded. He would endeavor to im- 
prove the nutrition of the walls, and bring about a 
change in the cavities that will secondarily influence 
the valves. He had therefore ordered him digitalis 
and extract of belladonna, and apparently with good 
results : — 

Ext. digitalis fluid., gtt.ij 

Ext. belladonnse fluid., gtt.j. M. 

Sig.— Ter die. 



HEMOKRHAGE. 177 

HEAT EXHAUSTION. See Sunstroke. 



HECTIC FEVER. 

To support the system in hectic fever, Prof. Gross 
ordered, with good food — 

Acid, sulph. aromat, gtt.xx 

Quininse sulph., gr.iij 

Ferri sulph., gr.ij. M. 
Sig. — Ter die. 

He advised for the night sweats of hectic fever, 
this pill : — 

Zinci oxidi, gr.ij 

Extract, hyoscyami, gr.ss. M. 

Ft. pil. 

HEMICRANIA. See Headache. 



HEMIPLEGIA. See Paralysis. 



HEMORRHAGE. 

As an anti-hemorrhagic combination, Prof. Bar- 
tholow speaks highly of — 

Extract, ipecac, fluid., f5ij 

Extract, ergotse fluid., f5iv 

Extract, digitalis fluid., f5ij. M. 

Sig. — Thirty minims to a drachm at a dose, pro re nata. 
12 



178 THE PRESENT TREATMENT OF DISEASE. 

To render blood more coagulable, when we have 
effusions of the same into cavities and so cannot 
ligate the bleeding orifices, Prof. Gross advises — 

Acid, gallici, gr.ij 

Digitalis foliorum, 

Ergotin., aa gr.j 

Opii, gr.ss. M. 

Sig. — Ter die. 

He advises the following when, after hemorrhage, 
it is desired to contract the arterioles, and to increase 
the plasticity of the blood : — 

Ergotin., 

Pulv. digitalis, aa gr.j 

Opii, gr.ss 

Plumbi acet. vel, gr.ij 

Acidi gallici, gr.iij. M. 

Ft. pil. 
Sig. — To be taken every four hours. 



Prof. Bartholow says that for hcemoptysis ipecacu- 
anha is a remarkable physiological remedy. In a 
clinical case it was given in combination, as follows : — 

Ext. ipecac, fluidi, 

Ext. ergot, fluidi, aa gtt.v. M. 

Sig. — At a dose. 



HEMOEKHAGE. 179 

For a young woman, set. thirty, suffering from 
haemoptysis, consequent upon incipient phthisis, 
Prof. Da Costa gave — 

Acidi sulphurici dilut., gtt.v 

Morphinse sulphat., gr.A" 

Elixir, simplicis, f§ss. M. 

Sig. — To be taken as required. 

She was also directed to take arseniate of sodium, 
gr. tu, ter die, after meals. 

In haemoptysis, when the usual remedies, as ergot, 
gallic acid, etc., have failed, he advises the use of 
the tincture of matico, in doses of f5ss-f5j, every two 
or three hours. 



Prof. Da Costa showed, at the Pennsylvania Hos- 
pital, a strongly anaemic rheumatic young man with 
mitral and aortic regurgitation, who suffered every 
two or three days with severe epistaxis, losing from 
Syj-xij each time. He was treated with ergot, styptic 
preparations of iron, gallic acid and tincture of 
matico, without avail, and he was much reduced by 
the repeated hemorrhages. He was then placed on 
copper sulphate, gr. xV, which was successful. He 
has had but one slight hemorrhage since. 

Prof. Bartholow, for a case of frequent epistaxis, 
occurring in a young man of twenty-five years of 



180 THE PRESENT TREATMENT OF DISEASE. 

age, recommended the following prescription, to 
maintain the tonicity of the blood : — 

Ergotse (aq. ext.), gr.ij 

Ferri sulphat., gr.j 

Extract, nucis vomicae, g r «i* M. 
SiG. — One pill, ter die. 

For a man having recurring epistaxis and a ten- 
dency to bleed from the gums, due to a malarial 
cachexia, Prof. Bartholow ordered the following pill 
to be taken, ter die : — 

Quininse sulphatis, gr.v 

Extracti ergotse, 

Mangani sulphatis, aa gr.ij. M. 



Gossypium as a uterine hcemostatic was a favorite 
remedy in the Jefferson Medical College Hospital. 
The fluid extract is given in half-drachm doses every 
four hours. 

For menorrhagia, independent of treatment di- 
rected to the cause, Professor Parvin recommends 
quinine, ergot and digitalis, but as the best treatment, 
water as hot as can be borne, in a rubber bag, to the 
lumbar region, and gallons of hot water injected into 
the vagina. If these fail, tampon the os uteri with a 
tent. Rest at next menstruation is to be directed. 



HEPATITIS. 181 

He considers opium one of the best remedies for 
uterine hemorrhage ; ergot the best for post-partum 
hemorrhage and that due to fibroid tumors. If the 
hemorrhage be due to malaria, quinine must be 
used. 

In Prof. Bartholow's experience, metrorrhagia 
produced by fibroids or fungous granulations is much 
more decidedly held in check by diluted sulphuric 
acid than by ergot ; while menorrhagia dependent 
upon ovarian excitement is generally more quickly 
relieved by bromide of potassium. 



HEPATITIS. 

Prof. Bartholow, in a clinical case of interstitial 
hepatitis (cirrhosis of the liver), stated that if there 
be a sufficient quantity of healthy liver substance 
remaining to carry on the function of the organ, 
the interference of the morbid process being re- 
moved and its progress arrested, we may succeed 
in restoring the man to comparative health. 

The problem is to restore the production of bile, 
and secure the discharge into the intestinal canal. 
We have therapeutic agents that will arrest this over- 
production of connective tissue, which is contracting 



182 THE PKESENT TKEATMENT OF DISEASE. 

upon the liver cells and causing their destruction. 
The phosphates and phosphites, particularly the 
former, may be used with a good prospect of success. 
The best, in view of its ready assimilation, is the 
phosphate of lime ; but, on account of its insoluble 
character, the question is how to introduce it into the 
system. When freshly prepared, it is soluble in 
lactic acid. In this form it is readily absorbed, and 
promotes digestion and assimilation. Phosphorus 
exerts an elective action upon the connective tissue 
of the liver. In phosphorus poisoning we find the 
hepatic connective tissue in the state of fatty degen- 
eration and destructive change. 

The metals, also, are generally thrown out by this 
channel, and in poisoning by the metallic salts, such 
as copper or antimony, the substance may be detected 
in this organ. In medico-legal cases, we always 
secure the liver, in order io examine it for poison. 
Arsenic particularly acts upon the hepatic structures, 
and after arsenical poisoning it may be detected in all 
the viscera, but is principally found in the liver. 
With this in view, he shall have two drops of Fow- 
ler's solution three times a day, given after meals : — 

Syrup, calcii lacto-phosphatis, f5j 

Liq. potassii arsenitis, gtt.j. 

Sig. — Ter die. 



HEPATITIS. 183 

We employ the arsenic in order to act upon the 
nutrition of the liver, and for its specific effect upon 
the connective tissue. 

A most important part of the treatment in hepatic 
disorders is careful regulation of the diet, which 
should mainly consist of such articles of food as do 
not require bile for their assimilation. We know 
that the bile emulsifies fats and favors their absorp- 
tion ; it also prevents fermentation in the starchy 
and saccharine elements. We must therefore give 
this patient substances that are converted into pep- 
tones in the stomach, and are thus readily absorbed. 
He shall have milk, fresh meat, eggs, and the succu- 
lent vegetables, such as contain but little sugar or 
starch (spinach, cabbage, cauliflower, etc.). 

It would be folly for the patient to expect that 
in a few days or weeks we will be able to en- 
tirely restore him, — especially if he disobey our 
instructions in regard to alcoholic drinks, which 
must be absolutely discontinued. Unless he faith- 
fully carries out his treatment, he will go on from 
bad to worse until the organ will be irretrievably 
damaged. 

The watery purgatives — the so-called hydragogue 
cathartics — are the chief means employed for getting 
rid of the ascites in cirrhosis of the liver. Prof. 



184 THE PRESENT TREATMENT OF DISEASE. 

Bartholow ordered in one case from one to two 
drachms of the compound jalap powder every 
morning. 

In cirrhosis of the liver, Prof. Da Costa recom- 
mended the persistent use of small doses of hydrargyri 
chloridum corrosivum (gr. -sir, ter die), with an 
occasional saline purgative to keep the portal circle 
unloaded. He teaches that in the early stages (before 
contraction) of interstitial hepatitis (cirrhosis) , a cure 
may be effected. He has seen the disease in women 
who did not drink, and the worse case he ever had 
was in a boy four years old, in which the diagnosis 
was confirmed at the autopsy. Inherited syphilis 
may be a cause of it. In the early stages the reme- 
dies are leeches, sulphate of magnesium, cream of 
tartar, iodide of potassium. 



In a clinical case of suppurative hepatitis, in a 
man thirty years old, he prescribed the following 
treatment : Aspiration would not yet be justifiable ; 
but poultices of flaxseed, to which should be added 
a little laudanum, were indicated. 

Quininse sulphat., gr.viij-x. 

Sig. — Ter die. 



HEKPES ZOSTER. 185 

And also — 

Tinct. ferri chloridi, 

Spirit, setheris nitrosi, aa gtt.xx 

Elixir, siraplicis, £5ss. M. 

Sig. — Ter die. 



HERPES ZOSTER. 

Prof. Bartholow stated, in a clinical case, that in 
the treatment of this affection the remedies are to be 
more particularly addressed to the nervous system. 
Recognizing the fact that it is an affection of the 
trophic filaments of the cutaneous nerve, the case 
can be treated intelligently. There are many reme- 
dies which might be used. One of the best prepara- 
tions is .chloral camphor, in which morphia has been 
dissolved : — 

Camphorae, 

Chloral., aa 5j 

Morph. sulph., gr.x. M. 

Sig. — To be painted over the affected part. 

This solution applied to the seat of disease relieves 
the pain and promotes healing. A mild stabile 
galvanic current, direct, is also a most effective 
remedy. If the pain is severe, the hypodermatic 
use of morphine may be required, or by the stomach 
a full dose of quinine and morphine may be given. 



186 THE PKESENT TEEATMENT OF DISEASE. 

As it is a self-limited disease, local anodyne applica 
tions will be sufficient, awaiting the effect of time. 



HODGKIIM'S DISEASE. See Lymphadenoma. 



HYPOCHONDRIASIS. 

In a clinical case of hypochondriasis, Prof. Bar- 
tholow stated that having decided that the central 
difficulty is disturbance of the digestive organs, and 
that the reflex symptoms are grouped about this 
centre, of course the first thing to be done is to 
restore the power of the digestive organs. It is not 
so much the quantity of the food as the quality that 
is to be regulated. The food must be of an easily 
digested and assimilable character, but any kind of 
food in considerable amount produces distress. 

The constipation must be relieved. Thus : — 

Extracti nucis vomicae, 
" belladonnas, 

" physostig., aa gr.J 

" aloes, gr.J. M. 

Ft. pil. 
Sig. — One three times a day. 

The nux vomica acts upon one part of the mus- 
cular layer of the bowel, while the belladonna acts 
upon another ; the physostigma has a powerful effect 
in increasing the secretion of the intestinal mucous 



HYPOCHONDRIASIS. 187 

membrane, and the aloes is, of course, directed more 
particularly to the condition called torpor of the 
intestine. 

The reflex nervous symptoms are due to irrita- 
tion of the terminal portion of the nerves in the 
stomach. The best remedy, under the circum- 
stances, is arsenic. We direct two drops of Fow- 
ler's solution of arsenic three times a day, before 
meals. This acts upon the terminals of the nerve, 
and upon the nervous apparatus. The pills pre- 
viously mentioned may be taken two or three hours 
after meals. Arsenic also has a decided effect upon 
the mental condition to which the term hypo- 
chondriasis is applied. Independently of the asso- 
ciated conditions, it promotes a feeling of well 
being. 

For sexual hypochondriasis, in a man set. twenty- 
six, Dr. Joseph Hearn, at the Jefferson Medical 
College Hospital, ordered the following : — 

Sodii bromidi, Sss 

Tinct. gelsem., 

Tinct. cannab. indie, aa f5j 

Aquae, 

Syrup., aa fSiij. M. 

SiG. — Two teaspoonfuls three times a day. 



188 THE PRESENT TREATMENT OF DISEASE. 

HYSTERIA AND HYSTERO-EPILEPSY. 

Prof. Bartholow alluded, in a clinical case of hys- 
teria, to the prevailing unphilosophical way of dis- 
posing of these cases. How often is such a patient 
directed to take Hoffman's anodyne, tincture of 
asafcetida, or something of the kind, which is never 
curative, but always a temporary expedient. It 
bridges them over the difficulty for a short time, but 
always leaves them worse than before. The rational 
treatment is first to seek out and cure the primary 
trouble. Correct the disorder of vision, correct the 
constipation, correct the diet, correct the vicious or 
sedentary habits of life, and the hysterical attacks 
will take care of themselves. 



He ordered for an hysterical girl with scanty 
menstruation, one of the officinal pills of asafcetida 
and aloes morning and evening, and one week before 
the expected menses the following pill : — 

Extract, nucis vomicae, gr.J 

Ferri arseniatis, gr.J 

Mangani sulph. dessic, gr.ij. M. 

Ft. pil. 
Sig. — One three times a day. 

He says the best thing for hysterical aphonia is 

atropine pushed to dryness of the throat. The voice 

reappears as if by magic. 



HYSTEEIA AND HYSTEB-OEPILEPSY. 189 

In a clinical ease of hysteria, dependent upon 
subinvolution of the uterus, he said that in applying 
remedies we should first endeavor to bring about a 
change in the condition of the uterus ; and, secondly, 
we must look after the digestion and assimilation. 
She may take — 

9. 

Extract, ergotse, gr.ij 

Ferri sulphat., gr.j 

Ext. nucis vomicae, gr.J 

Hydrarg. chlor. corrosiv., g r «^V« M. 
Ft. pil. 
Sig. — One ter die. 

This will improve the condition of the digestion 
and the state of the blood ; or, at least, there is hope 
that it will bring about a change in the functions of 
nutrition and blood-making, as well as act upon the 
uterus and promote involution. 



Prof. Da Costa prescribed for a clinical case of 
hysteria, the acute attack having been cured by the 
valerianate of zinc, the following : — 

Liq. arsenii chloridi, gtt.v 

Tinct. ferri chloridi, gtt.xv 

Syrup, simp., gtt.x 

Elixir, simp., ad f5j. M. 

Sig. — This dose to be taken ter die, after meals, well 
diluted. 



190 THE PRESENT TREATMENT OF DISEASE. 

Every night this pill to be taken — 

Aloin, gr.-^ 

Ex. belladonna?, g r «yV 

Rhei, g r «U- M« 



Prof. Bauduy; of St. Louis, in a paper on cocaine, 
states that there is nothing which relieves any of the 
ordinary manifestations of hysteria so rapidly and 
completely as a hypodermic injection of cocaine. 



In a clinical case of hystero-epilepsy, Prof. Da 
Costa prescribed the following : — 

Zinci valerianates, gr.ij 

Ext. cannabis indicae, gr.ss. M. 

Ft. pil. 
Sig. — Three times daily ; — 

and thirty grains of sodium bromide at night. 

Instruct him to live out of doors a good deal, and 
to try and divert his mind, and live a well-regulated 
life, and by following this regimen he may anticipate 
decided improvement. 

For hystero-epilepsy occurring in a young girl 
seventeen years old, he prescribed — 

Acid, hydrobromic. dilut., 5ss. 

Sig. — Bis die. 



ILEOCOLITIS. 191 

Constipation being a marked element, she was 
directed to take at night a pill consisting of — 

, Aloes, gr.J 

Ext. belladonna, gr-tV 

Capsici, gr.J. M. 

Prof. Bartholow, in a clinical case of hysterical 
convulsions, in an anaemic young lady fifteen years 
of age, who had passed through, without accident, 
the changes incident to puberty, and now menstruated 
regularly, said that one of the best combinations 
would be iron and arsenic, giving a mixture con- 
taining two or three drops of liquor potassii arsenitis, 
with five grains Vallet's mass. A change takes place 
in such a mixture, but at the same time it is a useful 
combination. This will be given three or four times 
a day, preferably after meals. 

In addition to the arsenic prescribed with this 
view, she should take ten drops of tincture of nux 
vomica, three times a day, to tone up the nervous 
system and diminish its excessive mobility. 

ILEO-COLITIS. 

A child suffering with this affection was treated 
successfully, at the Jefferson Medical College Hos- 
pital, under a properly regulated diet and the use 
of tincture of iodine and carbolic acid, the so-called 



192 THE PRESENT TREATMENT OF DISEASE. 

carbolate of iodine — a half a drop of each being 
taken three times a day. 



A case of ileo-colitis, occurring in a boy set. ten, 
was treated by Prof. Bartholow as follows : Cut off 
starchy and fatty substances of his diet, but give 
skimmed milk and beef juice; also the white of 
eggs, if this agrees with him, and three times a 
day give — 

Bismuthi subcarb., gr.xv 

Acidi carbolici, g r «i« M. 

See also Enter o-colitis. 



IMPOTENCE. 

In a clinical case of impotence, Prof. Bartholow 
spoke with confidence of — 

Ext. cannabis indicse, gr.x 

Ergotin. (aq. ex.), 3ij 

Ext. nucis vomicae, g r « x > M. 

Fiant pil. xx. 
Sig. — One, morning and evening. 

When there are present relaxation of the genital 
organs, diurnal losses and inaptitude for coitus, from 
irritability, he stated that the following may often be 
found very useful :— 



INCONTINENCE OF URINE. 193 

Ergotin. (aqueous extract), 3j 

Sanguinarinse, g r «U« M. 

Fiant pil. xx. 
SiG. — One pill, three times a day. 



When it is desirable to use ergotin hypodermati- 
cally, he recommends the following solution : — 

Ergotinse (aq. ex.), 5j 

Glycerin i, £5j 

Aquam dest., ad f§j. M. 

SiG. — Eight minims = gr. j of ergotine. 



INCONTINENCE OF URINE. 

At Prof. Da Costa's service in the Pennsylvania 
Hospital, chloral hydrate was given, in three-grain 
doses, ter die, for incontinence of urine in young 
children. 

Prof. Bartholow, in incontinence of urine, occur- 
ring in a girl twelve years of age, prescribed the 
following : — 

3. 

Ext. ergotae, gr.j 

Ext. nucis vom., gr.^ 

Ext. belladonnse, gr|. M. 

Ft. pil. 
Sig. — Take three times a day. 

13 



194 THE PRESENT TREATMENT OF DISEASE. 

Also 

Pil. ferri iodid. 
Sig. — One ter die. 

For a child, aet. three, with nocturnal and diurnal 
incontinence of urine, he directed that she be put 
upon a diet suitable to a child, as the food of adults 
would have a tendency to make the urine too stimu- 
lating to the bladder. To improve her general 
condition, fresh air and exercise, and syrup, ferri 
iodidi ; also, to increase the power of the sphincter 
vesicae, extract, ergotae fluid., gtt. xv, ter die. 



INDIGESTION. See Dyspepsia. 



INFLAMMATION. 

In inflammatory diseases, when patients cannot 
sleep, but require it, and unless there exists some 
contraindication* Prof. Gross prescribes — 

Potassii bromidi, 5ss 

Chloral., gr.xv 

Morphinse snlphat., gr.i 

Syrup. aurant., 

Aqua?, aa f5j. M. 

Sig. — Pro re nata. 

He suggests the following formula for an excel- 
lent cold application when indicated : — 



JAUNDICE. 195 

Potassii nitratis, 

Amraonii chlorid., aa 5v 

Aquse, Oj. M. 

The lead water and laudanum solution of Prof. 
Gross is as follows : — 

Plurabi acetatis, &ij 

Tinct. opii, fSss 

Aquse, f§viij. M. 
Sig. — Lotion. 



INFLUENZA. See Coryza and Hay Fever. 



INTERMITTENT FEVER. See Malarial Diseases. 



INTESTINES, DISEASES OF. See Gastro-lntestinal Ca- 
tarrh, Diarrhoea, Dysentery, Enteritis, Entero-Colitis, Ileo- 
colitis, etc. 



JAUNDICE. 

In a clinical case of this disease, Prof. Bartholow 
stated that the phosphate of sodium is the most 
efficient remedy for causing the catarrhal process to 
disappear, and to favor the flow of the bile into the 
intestine, given in drachm doses three times a day. 
In this case it will be advantageous to combine with 
it the arseniate of soda, in the dose of -fa of a grain 
three times a day. The malarial impression must 



196 THE PRESENT TREATMENT OF DISEASE. 

not be disregarded. The salicylate of cinchonidine 
must be given, five grains three times a day. This 
is a most efficient substitute for sulphate of quinine 
in ordinary malarial attacks. 

In another case of jaundice, after attending to the 
therapeutical and pathological diagnosis, he asked 
what should be done to relieve the swelling of the 
mucous membrane, to remove the obstructing mucus, 
and to get rid of the bile pigment which is dissemi- 
nated throughout the body, and upon the presence 
of which depend many of the symptoms. The 
patient was given the phosphate of sodium in tea- 
spoonful doses dissolved in a wineglassful of hot 
water, and taken as hot as possible before each meal. 
One of the objects of this is to liquefy the thick, 
tenacious mucus, and to prevent the fermentative 
changes in the duodenum which tend to keep up the 
catarrhal process. Again, the phosphate of sodium 
acting on the intestine, will, by reflex action, cause 
contraction of the gall bladder. It is in this way 
that at times the resinous cathartics do good in 
jaundice. The bile flowing down may dislodge the 
obstructing mucus. 

By common consent, mercurials are regarded as 
contraindicated in such cases as this, although there 
is a reason why calomel might be used. It has been 



JAUNDICE. 197 

proven beyond controversy that calomel, so far from 
increasing the flow of bile, actually diminishes it. 
This has been established by experiment on animals 
and also on man. In two important cases of biliary 
fistula, in Germany, in which all the bile was dis- 
charged externally, it was found that after a full 
dose of calomel, the result was the same as had 
previously been found to be the case in animals : the 
quantity secreted was diminished. It is this action 
which makes this remedy useful in certain cases of 
hepatic disease. If there were no other objections to 
it, it should be employed in the present case, but 
there are other remedies which are just as useful as 
calomel, without possessing its disadvantages. Phos- 
phate of sodium fulfils all the requirements. 

Often there is a malarial element, and unless this 
is removed, all remedies will prove inefficient. This 
patient had been taking from &\e to ten grains of 
quinine morning and evening. 

In the next place, it is desirable to get rid of the 
bile which is circulating in the blood, which irritates 
the skin, slows the heart and causes the unpleasant 
mental depression. This is best accomplished by the 
use of diuretics. The patient should drink freely of 
cream of tartar lemonade, ordinary lemonade, dis- 
tilled water, or some of the alkaline mineral waters. 



198 THE PRESENT TREATMENT OF DISEASE. 

For this purpose the alkaline waters of Michigan, 
the Bethesda water of Wisconsin, the Buffalo lithia 
water, or Vichy, may be employed. 



In a clinical case of chronic catarrhal jaundice, 
Prof. Da Costa stated that the main points in the 
treatment are to unload the portal circulation by 
active cathartics. Internally we give phosphate of 
sodium, a drachm daily in divided doses. It might 
be increased to two or even three drachms daily, if 
the stomach bears it well. Counter-irritation may 
be employed over the liver by painting with iodine ; 
or a cloth wet with a weak acid solution may be 
resorted to with benefit. A blister over the liver 
might also be serviceable. The fluid extract of 
jaborandi in drachm doses once a day as a temporary 
means of increasing the action of the skin and of 
the kidneys may be beneficial ; and to this patient 
he had also given arsenic for its influence upon the 
swollen mucous membrane. This has sometimes a 
very happy effect. 

Prof. Bartholow considers that when the cause of 
jaundice has been removed, salicylic acid will remove 
the bile pigment from the blood more promptly than 
any other drug. 



LAKYNGISMUS STRIDULUS. 199 

In ordinary cases of catarrhal jaundice, Dr. Neff, 
at the Jefferson Medical College Hospital, advised 
the application of a blister over a region marked by 
a line extending from the gall bladder to the ensiform 
cartilage. In a few hours after the application the 
bile pigment disappears from the urine, and the 
yellow hue of trunk and body rapidly fades. Phos- 
phate of sodium is given in conjunction. 



KIDNEYS, DISEASES OF. See Bright's Disease; Genito- 
urinary Organs, Diseases of, etc. 



LARYNGISMUS STRIDULUS. 

In a case of this disease — spasmodic croup — at the 
clinic, Prof. Bartholow said, that as it is merely a 
reflex spasm of the muscles of the larynx, remedies 
which relieve spasm are the appropriate ones to use. 
In the present case a remedy can be prescribed which 
has a twofold effect, — which benefits the intestinal 
inflammation, by acting through the nervous system, 
and is also very effective in relieving the muscular 
spasm. This is the bromide of potassium. In sum- 
mer complaint, bromide of potassium is one of our 
most efficient remedies, because it acts on the vas- 
cular supply of the mucous membrane, through the 
nervous apparatus, the semilunar ganglion and solar 



200 THE PKESENT TREATMENT OF DISEASE. 

plexus. He would direct five grains of bromide of 
potassium every three hours until the symptoms 
subside. The injunctions in regard to diet must be 
repeated. The child has been given bread in con- 
siderable quantity, with the idea that bread, being 
the staff of life, can do no harm. In such cases 
bread is unsuitable, because it is an eminently fer- 
mentable substance, and in the process of fermenta- 
tion acids are produced which have an irritating 
effect on the inflamed mucous membrane. 



In the treatment of laryngismus stridulus, the late 
Prof. Ellerslie Wallace highly approved of large 
doses of potassium bromide, given every hour or 
two ; for a child two years old, he would give six 
grains every two hours. It may be given in syrup 
of wild cherry, or in the form of elixir of potassium 
bromide, which is made by the pharmacists generally. 



LEAD POISONING. 

In a clinical case, Prof. Bartholow stated that the 
first thing is to secure the elimination of the lead 
which is deposited in the tissues. The iodides and 
bromides, especially the former, are remedies which 
will effect this elimination. They must be given in 
large doses ; it is useless to prescribe less than twenty 



LEAD POISONING. 201 

grains of iodide of potassium, four times a day, 
and if the stomach will bear it the dose will be 
increased to thirty or forty grains. The reason for 
giving such large doses is the rapidity with which 
diffusion and elimination of this remedy take place. 
Unless the system can be saturated, thus securing the 
diffusion into all parts of the body, no effect can be 
produced upon the lead, which is in a state of minute 
subdivision, in contact with the ultimate elements of 
the tissues. A small dose goes into the blood and is 
eliminated by the kidneys, and does not reach them. 
The dose must be larger than can be at once gotten rid 
of by the kidney. Purgatives and diuretics are also 
to be exhibited. To act on the bowels there is nothing 
better than Epsom salts, which, while being a laxative, 
will combine with any lead in the alimentary canal, 
and form the insoluble sulphate of lead. To increase 
the action of the kidneys, the patient will be ordered 
to drink freely of bitartrate of potassium lemonade. 

In the next place, the paralysis of the muscles 
must be relieved by electrical excitation and injection 
of strychnine. The first thing is the elimination of 
the poison, and the next the restoration of the con- 
sentaneous action between the brain and the muscular 
tissue, which has been interrupted by the presence 
of the metal. 



202 THE PRESENT TREATMENT OF DISEASE. 

In a clinical case of chronic lead poisoning, with 
delirium and tremor, Prof. Da Costa prescribed 
iodide of potassium, ten grains every four hours, if 
the patient's stomach would permit it, and also 
chloral and bromide of potassium. 



A boy, set. eighteen, a painter, was the subject of 
lead poisoning. Had great pain at defecation, etc. 
Was given, by Prof. Da Costa — 

Ext. belladon., gr.-| 

Rhei, gr.ij. M. 

Ft. pil. 
Sig. — One morning and evening. 

Also — 

Potassii iodidi, g r . x « 

Sig. — Ter die, until line on gums disappears. 

A favorite prescription of his, for the constipation 
of plumbism, is one drojD of croton oil made into 
eight pills, of which one is given two or three times 
a day. He has found that the liability to lead colic 
is greater where much turpentine is used. 

In a clinical case of heart and kidney disease 
dependent upon lead poisoning, Prof. Da Costa said 
that the patient, a fresco painter, forty-eight years 
of age, had had several attacks of lead colic, from 



LEUCOERHCEA. 203 

the inhalation of white lead, which he sometimes 
used in his business to dust on a freshly-painted sur- 
face. He had the blue line upon his gums. He had 
been vomiting, and was ordered a mixture of carbolic 
acid (gr. I), morphia (gr. -gr), in equal parts of muci- 
lage of acacia and peppermint water. His sickness 
of stomach had passed away, although his tongue was 
still coated and his bowels were constipated. He 
had also been taking strychnia (gr. 5V, ter die). 



Prof. Bartholow says that alum, by virtue of its 
astringency, is the most efficient purgative in lead 
constipation, by overcoming the relaxation and 
paralysis of the muscular layer of the bowel, on 
which the phenomena of lead-colic depend. 

In a case of " drop wrist " in an anaemic woman, 
he gave, to eliminate the lead, a scruple of sodium 
iodide, ter die, well diluted and on an empty stomach. 
On account of the anaemia, the potassium iodide was 
contraindicated, being a paralyzer. 



LEUCORRHCEA. 

Prof. Parvin prescribed for simple leucorrhoea :- 

Tinct. benzoin., fSj 

Aquae rosse, f5vij. M. 

Sig. — Put two ounces in a pint of water, and inject. 



204 THE PRESENT TREATMENT OF DISEASE. 

For a case of leucorrhoea and great vaginal irrita- 
tion in a child of eighteen months, he used, with 
success — 

Extract, opii, 

Extract, belladonna?, aa g r -TS" 

Iodoformi, gr.ij 

Olei theobromse, gr.v. M. 

Fiat suppos. vaginal, j. 
Sig. — Use one every day. 

In cases of leucorrhoea, associated with granular 

vaginitis, he uses for the latter condition nitrate of 

silver, combined with a tampon saturated with 5j 

each of alum and bismuth, the tampon to remain 

twenty-four hours. For simple cases of leucorrhoea, 

he uses an injection of chlorate of potassium, 5j to Oj. 



The following is a capital application in leucor- 
rhoea (Prof. Bartholow) : — 

Iodoformi, 5j 

Acidi tannici, 5j. M. 

Sig. — Pack q. s. about the cervix. 



LITH/EMIA. 

Prof. Bartholow says of the permanganate of 
potassium that it is the most appropriate of the 
oxidizing agents used in lithsemia. It is an efficient 
remedy for obesity due to faulty assimilation. 



LOCOMOTOR ATAXIA. 205 

As a strong solvent for urinary calculi, of the uric 
acid variety, he speaks highly of the tartraborate of 
potassium, in doses of a scruple ter die, in water. 



Prof. Da Costa usually treats a case of uric acid 
renal calculus with twenty to thirty grains of car- 
bonate of potassium in a glass of Apollinaris water 
three times a day. Soda water may be used instead 
of Apollinaris. This is for patients who cannot get 
Carlsbad water. He teaches that the evidence about 
nephrectomy for nephritic calculus is not conclusive. 
He says success is not so great as to make him very 
warm in its advocacy. Except under the extraor- 
dinary circumstances of its being the only chance of 
life, he would not advise its being done. When 
there exists an irremediable condition, with pus in 
the urine, aspirate first, and if there be further 
evidence of a stone in the kidney, cut down and 
remove it. 



LIVER, CANCER OF. See Cancer. 



LIVER, CIRRHOSIS OF. See Hepatitis. 



LIVER, INFLAMMATION OF. See Hepatitis. 



LOCOMOTOR ATAXIA. See Sclerosis, Posterior Spinal. 



206 THE PRESENT TREATMENT OF DISEASE. 

LUMBAGO. 

Prof. Bartholow prescribed for a case of lumbago 
salicylic acid internally, and externally the oil of 
wintergreen. 

In severe cases of lumbago, Prof. Da Costa advised 
acetate of potassium, 3j, four times daily, to be dis- 
solved in syrup of orange ; also — 

3, 

Atropinse sulph., g^-gV 

Morphinse sulph., g r -i« M. 

SiG. — Hypodermically. 



LYMPHADENOMA (HODGKIN'S DISEASE). 

In a clinical case of this disease, Prof. Bartholow 
stated that the treatment must be both systemic and 
local, the latter being the most important. Inter- 
nally, probably more good has been done by phos- 
phorus than by any other remedy. It is best given 
in xw-grain doses, dissolved in a drachm of cod -liver 
oil, three times a day. Good effects have also followed 
the use of the syrup of the iodide of iron and man- 
ganese. These may be given in combination with 
the phosphorus. Ergot sometimes does great good. 

The most important part of the treatment is the 
local treatment. The best local remedy is injection 
of arsenic into the affected glands. The amount of 



LYMPHADENOMA. 207 

arsenic said to have been used in some cases is almost 
incredible, as much as thirty to sixty drops of 
Fowler's solution having been injected at a time. 
In practicing the injection, either spray or a piece 
of lint moistened with chloroform is applied, to 
benumb the skin. The hypodermic needle is then 
inserted, and a few drops of Fowler's solution thrown 
in. The injections should be practiced on alternate 
days. Various other remedies have been used 
locally. Injection of iodine has been employed, 
but it is much more painful and less efficacious 
than arsenic. 

For the enlarged spleen, the Germans are in the 
habit of injecting arsenic into that organ. They 
do this with apparent impunity and with great 
apparent good. Many other remedies might be 
enumerated, but the most important are phosphorus 
with cod-liver oil, and the injection of arsenic. 



Prof. Da Costa had under his care a patient who 
had had Hodgkin's disease for fifteen years. The 
disease had been kept in check by living in a yacht, 
supplementary to treatment. He strongly urges 
arsenic, increased in dose until constitutional symp- 
toms are manifested, and kept there, as the best 
medicinal treatment. He believes that the disease 



208 THE PRESENT TREATMENT OF DISEASE. 

is not as uncommon as is supposed, being often con- 
founded with syphilis. Sometimes the diagnosis is 
difficult, but a microscopic examination of a removed 
tumor will often throw light on the case. 

In lymphadenoma, following scarlet fever in a girl 
of seventeen years, he prescribed — 

Acidi arseniosi, g r «iir 

Ferri sulph., g r -ij» M. 

Sig. — Ter die. 

Over the enlarged gla&ds rub — 

Ung. iodi, 

Ung. belladonnse, aa gss 

Carnphorse, g r «v. M. 

He recently showed the class at Pennsylvania 

Hospital a very severe case of lymphadenoma, which 

had been much improved by these means, viz. : 

Syrup, ferri iodidi, f5j, ter die ; Fowler's solution, 

gtt. v, ter die ; no stimulants allowed ; perfect rest 

and good food. Early surgical interference in such 

cases might possibly be beneficial. 



LYMPHATIC GLANDS, OBSTRUCTION OF. 

In a case of obstructive disease of the abdominal 
lymphatic glands, Prof. Bartholow said : There are 
certain remedies which do undoubtedly affect the 



MALARIAL DISEASES. 209 

lymphatics. Mercury is one. Iodine and the iodides 
are other remedies which have the same effect ; man- 
ganese and iron, under certain circumstances, also. 
Let this patient take twenty grains of iodide of potas- 
sium three times a day, and also one-twentieth of a 
grain of bichloride of mercury, with one grain of 
extract of cinchona three times a day, in the form of 
a pill. As you see, the iodide and mercury are not 
given together. A simple solution of the iodide is 
to be made, and the patient is to take twenty grains 
in four ounces of water, three times a day, before 
meals, so as to secure its diffusion through the system 
before the mercury is administered. It is always an 
error to combine these two remedies : such a com- 
bination does not, as is commonly supposed, produce 
the beneficial effect of both drugs. 



MALARIAL DISEASES. 

Prof. Parvin reported a case of intermittent fever 
occurring in an infant but one week old, which he 
cured by the rectal administration of a solution of 
quinine. 

Professors Bartholow and Da Costa agree that an 
antipyretic dose of quinine is not less than five grains 
every two hours until four doses are taken, or else 
thirty grains in two or three doses close together. 

14. 



210 THE PRESENT TREATMENT OF DISEASE. 

The former believes a small dose of morphine given 
with quinine is the best thing to counteract the 
unpleasant cerebral symptoms of the latter. They 
also recommend the following as a non-irritating 
preparation of quinia for hypodermatic use : — 

Quininse hydrobromat., gr.xlviij 

Aquae destillat., fSss. M. 

Dissolve, and by heat, if necessary. 
Sig. — Twenty minims contain four grains. 

It is readily dissolved in a little glycerine and water. 
It has, therefore, none of the irritating qualities of a 
solution in which an acid is employed. 



In a case of a young girl suffering from chronic 
malarial poisoning, Prof. Bartholow stated that the 
question which we have to consider is, how to best 
arrest the attacks. In order to prevent the occur- 
rence of the paroxysm, quinine must be administered, 
in anticipation of the seizure. The condition of the 
liver and spleen must be taken into consideration, for 
although there is no enlargement of the area of dull- 
ness proper to these organs, they are doubtless the 
seat of the changes which characterize chronic 
malarial toxaemia. The spleen in these cases is not 
necessarily enlarged, and may, indeed, as already 
stated, be smaller than normal. The organ may be 



MALARIAL DISEASES. 211 

in the condition known to practical pathologists as 
the " fleshy spleen." This is a chronic alteration in 
which the trabecule are very much increased in 
amount, and the splenic pulp proportionately dimin- 
ished. There are hypertrophy and hyperplasia of 
the connective-tissue elements, and hence its fleshy 
appearance. 

Two remedies to influence the liver and spleen are 
especially valuable. The one is aqueous extract of 
ergot and the other is an iodide, especially iodide of 
ammonium. There is also a condition of anaemia 
for which remedies of the chalybeate group are 
indicated. The most appropriate one in the present 
instance is the arseniate of iron. The best results 
will be accomplished by giving quinine, to prevent 
the recurrent attacks, and the use of a pill contain- 
ing the following : — 

Extracti ergotse, 3j 

Ferri arseniatis, gr.ss 

Ammonii iodidi, 5j. M. 

Fiant pil. xx. 
Sig. — Two pills three times a day. 

This prescription should be very persistently used. 



For a cheap prescription for intermittent fever, 
Prof. Da Costa considers the following very efficient — 



212 THE PRESENT TREATMENT OF DISEASE. 

Quininse sulphat., gr.xl 

Cinchonise sulphat., 5ij 

Chloroform., f5j 

Tinct. cardamomi comp., fgj 

Misturse acacia?, fSij 

Aquara, ad f§vj. M. 

Take a dessertspoonful three times a day. More 
frequently quinia (about twelve grains daily) is relied 
upon, in simple solution with dilute sulphuric acid 
and water (disulphate). 

He suggests the following as effective in the treat- 
ment of chronic malarial diseases : — 



M. 



If there be much enlargement of the spleen, ergot 
by the mouth or hypodermically is used. 



Quininse sulphat., 


gr-ij 


Ext. nucis vomicae, 


g r -i 


Acid, arseniosi, 


gr-A- 


Ft. pil. 




SiG. — One ter die. 





In a case of pure anaemia accompanying malarial 
cachexia, with slightly enlarged spleen, Prof. Da 
Costa put the patient upon sulphate of iron with 
carbonate of potassium (gr. iss each) in a pill, three 
times daily. In addition to this treatment, as his 
condition was good and his bowels were constipated, 



MALARIAL DISEASES. 213 

he gave him, in a pill, podophyllin, gr. |, extract of 
hyoscyamus, gr. ij, each night, and an additional 
pill in the morning, if needed. 

In a second case, an illustration of leucocythsemia 
with malarial cachexia, the patient took sixteen grains 
of quinine daily, which were reduced to ten grains, 
and, as he had noises in his ears, to six grains daily. 
He was also taking Basham's mixture. 



In a clinical case of tertian intermittent fever, 
Prof. Bartholow asked, in regard to the use of 
quinine : Shall we give small doses frequently 
repeated, or large doses less often ? The latter is 
the true mode. Give here fifteen grains three hours 
before the expected paroxysm. He preferred this to 
the other method, for this reason, which he regarded 
as indisputable : Quinine, though not eliminated 
from the system with great rapidity, yet is elimi- 
nated, and chiefly by the urine. If given in small 
doses early in the morning, by afternoon it would be 
eliminated, and would require to be repeated, and in 
larger amount, in order to check the paroxysm. 
Therefore, it is more economical, as well as more 
effective, to give a single large dose, which is also 
more agreeable to the patient; for fifteen grains, 
given at once, will give much less distress than one 



214 THE PRESENT TREATMENT OF DISEASE. 

grain every hour until the same amount be taken. 
Large doses obtund the sensibility of the cerebral 
centres, while smaller ones cause excitement of the 
brain and tinnitus. On the critical days of the return 
of the chills, the remedy should be repeated. 

But the quinine will not be sufficient to relieve a 
damaged liver, or to reduce an enlarged spleen ; in 
other words, the condition of chronic malarial poison- 
ing. Treatment must be directed to this object as well 
as to breaking up the chills, or they will inevitably 
return. Lugol's solution in five-drop doses, given in 
water before meals, and Fowler's solution, three drops 
after meals, always prove most efficient aids. It is 
best, about the twenty-first day, to give a full anti- 
periodic dose of quinine for three days, for by this 
time there is a much greater accumulation of morbid 
material in the blood than at the other periods named. 



Prof. Da Costa gives quinine in solution, if possible, 
mixed with a little spirit of nitrous ether to disguise 
the taste. In a case of masked malaria, he ordered — 

Quininae sulph., g r « xv j 

Acidi sulph urici, gtt.xvj 

Syrup, tolutan., fSj 

Spirit, aether, nitros., f5j 

Aquae, q.s. ad fgij. M. 

Sig. — Take in the morning, in three doses. 



MALARIAL DISEASES. 215 

For a marked case of malarial cachexia, with 
latent pleurisy, he prescribed the following : — 



Tinct. ferri chloridi, 


fSss 


Acid. acet. dil., 


fSiij 


Liq. ammorrii acet, 


«u 


Elixir, simplic, 


f5ix 


Strychninae sulph., 


gr.ss 



M. 

SiG. — Dessertspoonful ter die, to be doubled slowly. 

In addition, four grains of quinine, to be taken 
every morning before breakfast, directly after arising. 



In a case of chronic malarial intoxication, with 
enlarged liver and spleen, Prof. Bartholow advised 
as a topical application — 

Unguent, hydrargyri rubri, q.s. 

A piece the size of a pea to be rubbed into the 
skin thoroughly, preferably in the rays of the sun. 

Internal treatment consisted of the following pre- 
scription : — 

Cinchonidinse salicylate gr.v 

Ferri arseniat., gr.|- 

Extract, ergotse, gr.ij 

Amrnonii iodidi, gr.ij. M. 

SiG. — To be given in a wafer, three times daily. 



216 THE PEESENT TKEATMENT OF DISEASE. 

In a case of anaemia of splenic origin, due to 
malarial poison, with beginning leucaemia, Prof. Da 
Costa, at the Pennsylvania Hospital, prescribed at 
first chiefly quinine, given in amounts not exceeding 
sixteen grains daily, and occasionally mercurials, to 
relieve a tendency to constipation. As the patient 
did not materially improve, he gave him ergot, a 
drachm of the fluid extract three times a day, and 
reduced the quinine to tonic doses of six grains 
daily. 

In regard to the successful employment of ergot in 
this case, he said that there was no doubt the cure 
might be attributed to the ergot. He first began to 
use it hypodermically, but the patient objected, and 
finally refused to allow it to be given in this way. 
He was then given half a drachm thrice daily by the 
mouth, and in a week the dose was increased to a 
drachm of a trustworthy fluid extract, and his 
stomach had borne it well. 

He had adopted the rule to use ergot hypoder- 
mically in adults when a rapid result is desired, and 
where time is of less importance to give it by the 
mouth. The ergot acts by a constringing effect upon 
the blood vessels : the spleen being a very vascular 
organ, the ergot reduces the size of its blood vessels. 
What strikes one here is the interesting physiological 



MALAKIAL DISEASES. 217 

fact that, under the action of the ergot upon the 
spleen, the blood has become normal. He had not 
given him any iron. As his spleen came down in 
size the blood improved, although since admission he 
had had none of the remedies which are supposed to 
act upon the blood and increase the number of red 
corpuscles. He did not think it really necessary to 
continue the treatment, but the patient might take 
the following, chiefly for its strengthening effect : — 

Cinchonidise sulphatis, gr.ij 

Extract, nucis vomicae, gr.| 

Rhei, gr.j. M. 

Ft. pil. 
Sig. — One morning and evening. 

The effect will be tonic, and at the same time the 
pills will keep the bowels in a soluble condition, and 
thus prevent anything like abdominal fullness. 



Dr. Solomon Solis-Cohen, Chief of Clinic Out- 
Patient Department, Jefferson Medical College Hos- 
pital, in a paper read before the Philadelphia County 
Medical Society, thus summarizes the treatment of 
chronic malarial disorders : — 

1. Quinine salts are of greatest value in those 
cases of chronic malaria showing a distinct periodicity, 
and especially if there be a febrile paroxysm ; and in 



218 THE PRESENT TREATMENT OF DISEASE. 

such cases their chief value is prophylactic, rather 
than curative. The administration of quinine until 
relief is manifested, and then the withdrawal of the 
drug, will sometimes bring out a periodicity other- 
wise masked. The bimuriate of quinia and urea 
hypodermatically is the preferable salt in acute or 
subacute exacerbations occurring in the subjects of 
malarial cachexia. 

2. In cases where the patient is much run down 
and exposed to unsanitary conditions, iron should be 
part of the medicinal treatment. 

3. Where the most prominent symptoms are con- 
nected with the nervous system, including apparent 
pulmonary, cardiac, intestinal or gastric troubles, 
arsenic is indicated. 

4. Where the most prominent symptoms are rheu- 
matoid or myalgic in character, salicin, or some of 
its derivatives or compounds, is of advantage ; cin- 
chonidine salicylate, by preference, in order to obtain 
the anti-malarial virtues of the cinchona alkaloid. 
Cinchonidine salicylate is also of use in maintaining 
an effect produced by quinine, after the withdrawal 
of that drug, and is superior to quinine where the 
paroxysmal manifestations are vague and irregular. 

5. Iodine is of some benefit when administered 
alone, and of decided benefit when combined with 
other remedies. 



MENINGITIS. 219 

MEASLES. 

Of the treatment of measles, Prof. Da Costa 
speaks as follows : Do as little as possible. Tinct. 
aconit. rad. in neutral mixture, for fever, if necessary. 
Keep patient warm. Look out for complications. 
No need of prevention against its spreading. Better 
let all children of a household get the disease, and 
thus be safe against it when older. 



MENINGITIS. 

A man, aged sixty-five, suffering from a local 
chronic meningitis, due to a fall, and of seven years' 
duration, was placed upon the following treatment 
by Prof. Da Costa : — 

Acidi hydrobromici dilut. 5ss 

Syrupi simplicis, 

Aquae destil., aa f5j. M. 

Sig. — Ter die. The dose of the acid to be increased to 
3j ter die. 

Purgation was indicated, and to this end he was 
given — 

3, 

Podophyllum, gr.j 

Aloes, gr.j 

Extract, hyoscyami, gr.j. M. 

Ft. pil. 
Sig. — One each night. 



220 THE PRESENT TREATMENT OF DISEASE. 

Dr. Longstreth had a very bad case of chronic 
meningitis, at the Pennsylvania Hospital, which 
very much improved under the use of potassium 
iodide and arsenic. 



MENORRHAGIA. See Hemorrhage. 



METRORRHAGIA. See Hemorrhage. 



MIGRAINE. See Headache. 



MYALGIA. 

Dr. James C. Wilson,* Physician to the Phila- 
delphia Hospital, thus describes the treatment of 
myalgia : — 

In acute cases, due to overwork pure and simple, 
and where complete rest is attainable, little other 
treatment is required. In the course of a few hours 
or days the function of the muscles is fully restored 
and their contractions are performed without pain. 
When, however, complete muscular relaxation is 
impracticable or fails to afford relief, anodynes are 
necessary. Morphia hypodermically is very useful, 
but this altogether independently of any local action. 
The continuous application of dry or moist heat by 
means of hot-water bags, flannels, poultices, spongi- 

* Philadelphia Medical Times, Nov. 14th, 1885. 



MYALGIA. 221 

opiline, etc., is also useful. Anodyne lotions do 
good, and liniments containing aconite, belladonna, 
chloroform or chloral may be especially recom- 
mended, as may also the compound belladonna 
liniment of the British Pharmacopoeia. Plasters of 
belladonna, conia and menthol also relieve pain. 
Galvanism occasionally gives prompt relief. The 
same statement may be made of static electricity. 
The pain sometimes disappears under gentle and 
long-continued massage. 

In severe cases rest in bed becomes a necessity. 
In affections of the respiratory muscles, as pleuro- 
dynia, firm support of the side by means of over- 
lapping strips of plaster drawn from the spine 
downward and forward, in the direction of the ribs, 
to the median line in front, is sometimes necessary 
and always comfortable. 

The balance of nutrition is restored by rest. 
Local means to further this end are such as relieve 
pain — namely, heat, anodyne and stimulating fric- 
tions, massage and galvanism. The parts must be 
protected from sudden changes in temperature by 
extra thicknesses of flannel or sheets of wool or 
cotton batting, covered, if necessary, with a piece of 
oiled silk or fine gum cloth. In old cases, prolonged 
massage, with passive movements, and the slowly- 



222 THE PRESENT TREATMENT OF DISEASE. 

interrupted galvanic current alternating with rapid 
faradic currents, are followed by good results. 

As constitutional measures, a Dover's powder at 
night, followed by mild purgation in the morning, 
is often indicated. Purgation is especially called for 
in plethoric or gouty persons, in whom also Turkish 
or vapor baths are af good service; while poorly- 
nourished anaemic subjects demand quinine, iron, 
lime and cod-liver oil. If the attack linger, full 
doses of ammonium chloride, and, in old cases, of 
potassium iodide in moderate doses, well diluted and 
long continued, are advocated; and in stubborn 
cases Anstie recommended deep acupuncture of the 
muscle near its tendinous attachment. In cases 
marked by a tendency to spastic rigidity, the re- 
peated hypodermic injection of atropine may often 
be relied upon as the speediest means of cure. 
Where the general nutrition is poor, the local trouble 
is apt to be obstinate, and often yields only to meas- 
ures that restore the general health. 



For myalgia, Prof. Da Costa prescribed, in a 
clinical case, the following lotion : — 

Chloral., Sj 

Lin. saponis comp., f§ij. M. 



NEURALGIA. 223 

NASAL CATARRH. See Catarrh, Nasal. 



NEPHRITIS. See Bright's Disease. 



NEURALGIA. 

In a case of neuralgia of the arms, Prof. Bartho- 
low stated that, as the pain is chiefly nocturnal, and 
as we have evidence of some inflammation, the most 
appropriate remedy will be iodide of potassium, 
which is useful in neuralgia, with nocturnal exacer- 
bations, irrespective of its specific origin. Descending 
galvanic currents, labile and stabile, from fifteen or 
twenty cells, are recommended, one electrode being 
placed over the brachial plexus and the other on the 
hand. 

If the pain is not relieved by these measures, the 
hypodermic injection of certain anodynes is to be 
tried. We should first use the remedy which is of 
the least doubtful propriety, that is, the injection 
of water, the injection being practiced over the course 
of the nerve. At each point where the nerve 
becomes superficial, from half a drachm to one 
drachm of water may be injected. If this fails, one- 
sixteenth of a grain of morphine may be used, and, 
finally, if the case becomes chronic, a few drops of chlo- 
roform should be injected in the vicinity of the nerve. 



224 THE PRESENT TREATMENT OF DISEASE. 

He presented at the clinic a case of neuralgia, 
or tic douleureux, neuralgia of the superior maxil- 
lary branch of the fifth nerve. There is no fact 
in therapeutics more striking than the curative 
results of a few drops of chloroform injected in the 
neighborhood of this division of the nerve, when it 
is the seat of neuralgia. Simply lift the corner of 
the lip and insert the needle at the junction of the 
mucous membrane of the lip and that of the cavity 
of the mouth, and pass it up until its extremity 
comes in the neighborhood of the nerve, and inject 
from five to fifteen drops of chloroform or ether. 
As a rule, chloroform is less painful and more effi- 
cient than ether. In this case the pain at once 
subsided, and in the majority of cases the result, if 
not permanent, lasts for a considerable length of 
time. He had a patient in Boston, who came to him 
twice a year to have this injection practiced. In his 
case the neuralgia was probably due to intra-cranial 
disease. The relief which he obtains is complete, 
and lasts never less than six months. 



Prof. Bartholow treated a case of intercostal neu- 
ralgia by the application of a cone of chloral and 
menthol, moulded by the aid of spermaceti, directly 
to the seat of pain. 



NIGHT TERKOKS. 225 

He recommends for superficial neuralgia that a 
five to twenty per cent, ethereal solution of menthol 
be painted over the part. He had also found the 
following of benefit, applied externally : — 

01. caryophylli, 

Ol. gaultherise, 

Ol. thy mi, aa 5j 

Tinct. benzoini, 

Tinct. cinnamomi, aa §iv. M. 

He treated a case of cervico-brachial neuralgia by 
the subcutaneous injection of gr. | of cocaine hydro- 
chlorate in the neighborhood of the affected nerve. 
The injection of morphine and atropine in combina- 
tion might also be used. In the chronic variety he 
would greatly prefer ether or chloroform used in the 
same manner. 



Prof. Parvin recommends the following for uterine 
neuralgia : — 

Quininse sulphat., gr.viij 

Camphor, pulv., gr.ij 

Morphinse sulph., gr.J. M. 

Sig. — Give in anticipation of the expected paroxysm. 



NIGHT TERRORS. See Epilepsy, Nocturnal. 

15 



226 THE PRESENT TREATMENT OF DISEASE. 

NYMPHOMANIA. 

In a clinical case of this affection, Prof. Parvin 
prescribed the direct application of muriate of cocaine 
to the genital organs, and the internal administration 
of five to ten drops of Fowler's solution three times 
a day, with a milk diet. The vaginal spasm and the 
other symptoms had been greatly relieved. He 
believed that this was the first time that muriate 
of cocaine had been used for this purpose, and the 
results were such as to justify its application in other 
cases. It seemed to him an entirely rational way of 
treating this disorder in certain cases. Lower the 
exalted sensibility of the two chief centres of sexual 
pleasure ; not only lower that sensibility, but blunt 
it. This patient had expressed herself very grateful 
for the benefit that she had had from the cocaine 
treatment. 



OBESITY. 

In a clinical case of obesity, Prof. Bartholow pre- 
scribed the following line of treatment : She had 
been eating articles which produce fat — farinaceous 
vegetables, bread and butter, with coffee, starches, 
etc. She takes the juices of meats, with sauces, but 
does not eat meats. To lessen this tendency to 
obesity, her diet must be changed gradually. Let 



(EDEMA. 227 

the patient eat meats, except pork and duck and 
salted meats. Interdict fried fishes and meats. Let 
her take succulent vegetables, that contain the least 
amount of starch, as stewed apples, boiled onions, 
with skimmed milk and eggs. Acid fruits are 
of avail. Allow hot milk as a substitute for 
tea, etc. 

For her obesity and myalgia also give — 

Potass, permang., gr.ij 

in pellets, four times a day, in filtered water. It will 
relieve the pains and check obesity. Uric acid will 
be eliminated. Exercise is of paramount import- 
ance, and should be taken regularly, a few hours 
after meals. 



(EDEMA. 

In a clinical case of acute general oedema without 
kidney, heart or blood affection, Prof. Da Costa 
considered this an illustration of what the old writers 
called inflammatory oedema, and to which he applies 
the term catarrhal oedema. The lesion is principally 
in the areolar tissue. The patient recovered in about 
a week, under an active diaphoretic treatment. At 
first, ammonium acetate was given; afterward, jab- 
orandi. 



228 THE PRESENT TREATMENT OF DISEASE. 

PARALYSIS. 

A remarkable series of coincidences occurred in 
Prof. Da Costa's clinic. Five patients presented 
themselves for the first time, suffering from paralysis 
of certain groups of muscles, due to over-taxation. 
The first four were treated with strychnine hypoder- 
matically ; the last, since the above plan would be 
injurious, was given — 

Strychninae sulph., gr.j 

Acidi phospborici dilut., 
Elixir, simplicis, aa f§j 

Aquam, ad fSiv. M. 

Sig. — f5i ter die. 



A clinical case of vaso-motor paralysis was shown 
by Prof. Da Costa, a girl, aet. fourteen, a seamstress 
by occupation. Her hands were purple, but this color 
disappeared on pressure. There was marked swelling 
of the hands; no heart lesion. The cause of the 
disorder lay in the fact that the nervous supply 
of the capillaries was cut off, so that the vessels 
dilated. She had not yet menstruated. She was 
given aloin, gr. A, every night ; also, f5ss of fluid 
extract of ergot, twice daily. This latter would 
contract the capillaries, and also aid in bringing on 
normal functions. 



PARALYSIS. 229 

The specific at the Jefferson Medical College Hos- 
pital for paralysis due to pressure of the main nerves 
of a limb is a blister along the course of the affected 
nerve. At the same time the patient takes an active 
purge. 

In a clinical case of infantile paralysis, in a child 
of fourteen months, Prof. Bartholow observed that 
the treatment consists, first, in the use of remedies to 
improve the local condition of the paralyzed parts, 
and, above all things, to prevent wasting of the 
muscles. In some cases the special stimulants to 
the spinal cord may be used with great advantage. 
Strychnia injected into the paralyzed muscles will 
prove very beneficial if given after the first few 
days, but he would particularly advocate the applica- 
tion of the galvanic current to the affected limbs 
daily ; the galvanic current, not the faradic. The 
galvanic current slowly interrupted will generally 
produce definite contractions of the muscles ; if it 
does so in a given case, you can promise improve- 
ment, if the disease is not far advanced. After a 
while you will find that the muscles, which at first 
would only react to the galvanic current, will now 
respond to the faradic; and then faradism or the 
induced current may be substituted. 



230 THE PRESENT TREATMENT OF DISEASE. 

In regard to the treatment of the lesion in the 
spinal cord, we have remedies that will improve the 
nutrition of the cord, such as the tincture of nux 
vomica and the syrup of the iodide of iron, which 
the little patient has been taking for a short time 
with very marked improvement. Thus far there 
has been no systematic treatment directed to the 
muscles. Electricity should be applied for ten or 
fifteen minutes daily, as already indicated, and the 
muscles rubbed and kneaded by the mother's hand, 
so as to keep up their nutrition until the nerve 
power is restored. 

Remember that this condition comes on suddenly 
in young children after a slight fever, that it may 
generally be relieved by prompt treatment, and that 
electricity should not be applied during the continu- 
ance of the fever. 

A child fifteen months old, presenting a case of 
spinal paralysis, due to irritative lesion following 
fever from teething, was given, by Prof. Da Costa, 
the following : — 

9- 

Potass, bromidi, gr.ij 

Potass, iodidi, gr.ss 

Syr. zingiberis, f5ss 

Liq. potass, citrat., f3ss. M. 

Sig. — Ter die. 



PAHALYSIS. 231 

The application of cold to the spinal column is of 
much value in these cases. 



For a case of infantile paralysis of two or three 
weeks' duration, in a girl set. four, in which the 
paralysis involved the right upper extremity and the 
left lower extremity, Prof. Bartholow brought about 
a good result by massage ; also the administration 
of lactophosphate of calcium with ol. morrhuse. 
Strychnia was injected into the muscles. 



In a case of hemiplegia following enlargement of 
the parotid gland and the lymphatic glands of the 
right side of the neck, Prof. Bartholow prescribed, 
with successful result, one-half a grain of sulphate 
of iron with tttf of a grain of sulphate of strychnia 
three times a day. 

In a clinical case of hemiplegia following scarla- 
tina in a child, he said that in cerebral extravasa- 
tions, the clot of blood would by pressure cause the 
surrounding area to undergo atrophic changes, which 
can only be partially restored. In the course of 
time the patient will recover more or less, but never 
entirely, for this degeneration takes place all along 
the motor tract at the base of the brain and into the 
anterior columns of the medulla oblongata and spinal 



232 THE PEESENT TEEATMENT OF DISEASE. 

cord. In many cases electricity should be applied, 
if only to prevent further degeneration of the 
muscles, for the patient would proceed from bad 
to worse without it. Decided benefit might result, 
however, from the systematic daily application of the 
current, rubbing of the affected limbs, and due atten- 
tion to general nutrition, with occasional tonics and 
nourishing food. 

In a clinical case of embolic hemiplegia, Prof. 
Bartholow said that, in the treatment of such a 
case, if seen early, it is well to begin by adminis- 
tering an alkali, because these emboli are soluble in 
alkaline blood. This may be done by the adminis- 
tration of carbonate of ammonia, and cases of this 
kind are found to be greatly improved in this way. 
This case had advanced too far. What we have to do 
is to improve the general nutrition, and, secondly, to 
restore the power to the limbs. We may favor this 
by the administration of the lactophosphate of lime 
and the hypophosphites ; and, secondly, by farad izing 
the muscles ; for, if neglected, the muscles will still 
further atrophy. 

In another case of embolic hemiplegia of long 
standing, he directed that the patient should take 
tinct. physostigmatis, gtt. xv, ter die. 

In a clinical case of hemiplegia consequent upon 



PARALYSIS. 233 

syphilis, he prescribed potassium iodide, with small 
doses of the corrosive chloride of mercury, in con- 
nection with tonics. 



In a clinical case of paraplegia from interstitial 
myelitis, Prof. Bartholow said that the patient should 
have remedies to improve the digestion ; but there are 
also remedies having an influence upon the nutrition 
of the spinal cord. This is a case of interstitial 
disorder, affecting the connective tissue of the cord 
rather than the nerve , elements. Certain agents 
have the power to relieve this condition of the con- 
nective tissue ; these are the chloride of gold and the 
bichloride of mercury. She may take one-twentieth 
of a grain of chloride of gold, in pill form, three 
times a day, after meals. As it is also desirable to 
exert an alterative influence, she shall have two 
drops of the compound iodine solution thrice daily, 
which has a remarkable power to improve the appe- 
tite and digestion. Often a single drop of Lugol's 
solution will arrest vomiting and pain in the stomach. 



Two clinical cases of paralysis agitans illustrated, 
in Prof. Da Costa's hands, the effects of hyoscyamine 
in this disease. He began with gr. 2Tnr, ter die, and 
pushed it to tolerance. Use it thus for four to six 



234 THE PEESENT TREATMENT OF DISEASE. 

weeks ; then alternate with liquor potassii arsenitis, 
gtt. ij-v, for some time, and return to the hyoscya- 
mine. To make the treatment still more effective, 
use a galvanic battery of 10-12 cells every second 
day. 

In a second case, the patient — a woman of fifty- 
nine — had been on hyoscy amine for two years, and 
had greatly improved. She began by taking 2 hu gr., 
and was now taking the same remedy, in doses of 
gr. -so, ter die. He placed her upon quinine, gr. x a 
day, in two doses of gr. v each, and hyoscyamine, 
gr. -h ter die. 

For a case of paralysis agitans in a man sixty-five 
years old, Prof. Bartholow prescribed hyoscyamine, 
gr. sV once every day, and morning and evening, 
picrotoxin, gr. eV. As he presented the aspect of 
sclerotic changes, he was also given the lactophosphate 
of lime. 

PARAPLEGIA. See Paralysis. 



PERITYPHLITIS. See Typhoid Fever. 



PERTUSSIS. See Whooping Cough. 



PHTHISIS. See Consumption. 



PLEUKISY. 235 

PLEURISY. 

Prof. Da Costa, in lecturing upon pleurisy, gave 
the following outline of the treatment : — 

1. Acute Pleurisy. — In the early stage, when 
effusion has not yet taken place, the question arises, 
Shall we employ local blood-letting ? In a young, 
vigorous adult it is good practice to withdraw from 
fSviij-xij of blood. Follow the cups by a poultice, 
on which place sufficient laudanum. This is a com- 
fortable application. If we do not employ venesec- 
tion, poultice at once and use counter-irritants. 
Subcutaneous injections of morphia in small doses 
near the inflamed pleura are of great value. It is 
of importance to keep the patient under the influence 
of an opiate. Dover's powder is a convenient form. 
Control the circulation by the use of tincture of 
aconite, in drop doses every hour, as indicated by the 
heart. 

When effusion has taken place, do not cup ; nor is 
aconite indicated, since the heart is displaced. At 
this stage the acetate of potassium and digitalis are 
of great value, Sss of the acetate to be given in 
liquor potassii citratis, in the twenty-four hours. 
Digitalis may be advantageously combined with the 
above. In a strong man, when the effusion persists, 
jaborandi is often of decided value. The iodide of 



236 THE PRESENT TREATMENT OF DISEASE. 

potassium is a most useful agent when the effusion 
tends to linger. During its use, add small blisters, 
repeated occasionally. Often in these cases a gentle 
mercurial impression will start the effusion; then 
follow up with diuretics as well as diaphoretics. 
Sustain the strength, especially in lingering cases, 
by the use of stimulus. 

When the effusion is overwhelming, the question 
of paracentesis comes before us. When delirium 
begins, and circulation and respiration become irreg- 
ular, then it is time to tap. If the effusion be 
double-sided, then aspirate ; but, as a rule, a double- 
sided pleurisy occurs in tubercular patients, so that 
tapping will not materially lengthen life. 

2. Chronic Pleurisy. — This is both medical and 
surgical. In the medical treatment we have two 
remedies of great value, to wit : Basham's mixture, 
fSss, ter die, with strychnia, gr. sV, ter die. Begin 
their use before pus has formed, for then only 
surgical means are of avail. The second remedy 
of utility is the iodide of potassium, to which add 
the use of small blisters. When irritative fever sets 
in, use quinia and digitalis. In weak persons, ol. 
morrhuse is of great benefit. Chronic pleuritic 
effusion may sometimes be removed by half-drachm 
doses of fluid extract of jaborandi, given two or 



PNEUMONIA. 237 

three times daily, just sufficient to keep up free 
action of the skin and kidneys. 

When surgical treatment becomes necessary, some 
advise tapping always when fluid is present. Prof. 
Da Costa does not employ tapping as frequently as 
he did : the after results are not always favorable. 
Always select your cases for the operation. 

The following directions are suggested for the 
operation of tapping : 1. Never tap until you have 
tried medical means. 2. Don't wait a day, if pus be 
present. 3 In doubtful cases better tap, since medi- 
cine will not remove pus. Suppose your patient 
should take medicine for six months, and no result, 
when suddenly some fever develops : you may not 
fully believe that pus has formed in this case, but 
"tap, anyway." 4. Better tap more than once than 
leave a drainage tube in the cavity. 5. In large, 
purulent effusions the tube may be used, but it 
produces fever. 

Injections. — Prof. Da Costa prefers tincture of 
iodine ; carbolic acid may be used, or corrosive 
sublimate in weak solution. 

(See also Pneumonia.) 



PNEUMONIA. 

The treatment of ordinary marked sthenic pneu- 
monia (croupous) , as laid down by Prof. Da Costa, is 



238 THE PRESENT TREATMENT OF DISEASE. 

the following : Do not bleed, as a rule ; though, in a 
strong man with strong pulse, you will relieve the 
headache and dyspnoea in the early stage. In later 
stage a few wet cups, in the same condition, will be 
of much avail. Keep down the circulation, at any 
rate, by one of two remedies, to wit : Tinct. aconite, 
gtt. j-ij, in diaphoretic mixture, every two hours, or 
tinct. veratrum viride, gtt. iij-v, in syrup of ginger, 
until an impression is produced on the pulse. In 
conjunction, quinine, gr. viij-xij per diem, will be 
found beneficial. 

As the case goes on, and the circulation is to be 
further controlled, the use of digitalis is indicated. 
Act on the secretions and keep them up; keep 
patient quiet. Give him Dover's powder at night. 

Quinine is to be given throughout the course of 
the disease. In the second stage expectorants are 
valueless, but may be used later, when tissue breaks 
down, etc. Then use ammonium chloride or ammo- 
nium carbonate. The latter is also a stimulant to 
the circulation, and also breaks up exudation. Give 
it in doses of gr. v-vij, every two or three hours. 
The aromatic spirits of ammonia may be substituted 
for it, in doses of f5ss, given in simple elixir. 

Plain food should be given : oysters or fluid food. 
We may give the patient almost what he wants. 



PNEUMONIA. 239 

Stimulus is required for the symptoms, but not for trie 
disease; i. e., a flagging pulse, a weak heart, call for 
whiskey. In this state of affairs give fSss every two 
or three hours. If the ease passes into the stage of 
general exhaustion, give whiskey freely. 

In typhoid pneumonia give ammonium carbonate, 
quinine, digitalis and stimulus from the very onset. 

Local Treatment. — If some pleurisy exists, poul- 
tice ; but cease when pain stops. Glycerine for 
circumscribed pleurisy and lingering consolidation. 



The treatment of catarrhal pneumonia, according 
to Prof. Da Costa, is the following : Inhalations of 
carbolized spray, with the administration of ammo- 
nium chloride (gr. v-xx), potassium iodide (gr. iii-v) 
given in compound licorice mixture (oss), or elixir 
of yerba santa, if there is much spasmodic cough, 
have given decided results. Night sweats are con- 
trolled by ergot or atropia, and emulsion of cod-liver 
oil and extract of malt, if the nutrition is below par. 
A moderate amount of stimulant may be required; 
and if there are great daily fluctuations in the tem- 
perature, indicating the onset of pneumonic phthisis, 
the pill of digitalis, quinia and opium (Niemeyer) is 
used three times a day. 



240 THE PEESENT TREATMENT OF DISEASE. 

Dr. Neff, of the Jefferson Medical College Hos- 
pital, prescribed the following treatment in a clinical 
case of pneumonia which had been complicated with 
typhoid fever. The pneumonia was treated by 
quinine, grs. xx per diem, in doses of five grains 
per hour, beginning at 5 a. m., to which was added 
whiskey, oxij, during twenty-four hours. The 
typhoid fever was treated with carbolic acid and 
iodine. 

For a case of catarrhal pneumonia of the left apex, 
Prof. Da Costa gave — 

Sodii iodidi, gr.v 

Morphinse sulph., g r «^V 

Elixir, simplicis, f5j. M. 

Sig. — Ter die. 

Blisters were advised over the apex. 

For a case of syphilitic lobar pneumonia, he 
advised — 

Ammonii iodidi, gr.v 

Spirit, ammonii aromat., gtt.xv 

Elixir, simplicis, f5ss 

Aquam, ad f^j. M. 

Sig. — Ter die. 

To this was also added a pill consisting of — 



PNEUMONIA. 241 

3- 

Digitalis, gr.ss 

Quininse sulph., gr.j 

Ext. opii, gr.J 

Ext. ipecac, gr.J. M. 

In the early stage of a clinical case of pneumonia, 

he gave : — 

Tinct. verat. virid., gtt.iij 

Liquor, potass, citratis, f5iij 

Spirit. setheris nitrosi, f5ss 

Syrup, zingiberis, ad f§ss. M. 
Sig. — Every three hours. 



The dose of chloral habitually given by Prof. 
Bartholow is gr. xv, not repeated before two hours. 
He says its importance in all acute inflammations is 
not adequately recognized, but special caution must 
be used in pneumonia. Its best antidote is the con- 
joined use of artificial warmth, atropine and picro- 
toxin, general principles being observed. 

He says that ether, employed hypodermatically 
in pneumonia, is one of the greatest advances in 
the treatment of this affection, and is surprised 
that it is not more frequently used to tide the case 
over the crisis in typhoid pneumonia. It should 
be given one, two or three times in twenty-four 
hours. 

16 



242 THE PRESENT TREATMENT OF DISEASE. 

Prof. Bartholow treated a case of pleurisy com- 
bined with pneumonia of low grade, with ammonium 
iodide gr. v every eight hours, and ammonium car- 
bonate, gr. v, dissolved in spirits of mindererus 5j, 
every eight hours, so taken that one remedy would 
be taken every four hours. He speaks highly of the 
use of ethyl iodide, when the local effect of the drug 
is desired, as in caseous pneumonia. 



PREGNANCY AND PARTURITION, AFFECTIONS AND 
ACCIDENTS OF. 

For painful breasts after parturition. Prof. Parvin 
uses — 

Ol. olivse, foij 

Tinct. opii, f§j. M. 

He regards an absolute milk diet as the very best 
means of treating albuminuria of pregnancy, and a 
milk diet as most important in the hydrcemia of 
pregnancy. Ferrum redactum is the best form in 
which to administer iron in this condition. He 
recommends, among other remedies for salivation in 
pregnancy, the smoking of a fourth of a cigar several 
times a day. 

Among the numerous remedies recommended for 
relief of sore nipples, he pronounces the compound 



PREGNANCY AND PARTURITION. 243 

tincture of benzoin the best, as a local application. 
As the saliva of the infant is liable to be productive 
of fissures, etc., by its irritation, the nipple should 
always be carefully cleansed and dried after the 
nursing of the child. 

Prof. Parvin teaches that, while there is no single 
plan of treatment applicable to all cases of placenta 
prxvia in general, this treatment may be compre- 
hended in the alliterative phrase, — Temporize, tam- 
pon, turn. Temporize if the hemorrhage be not so 
great, and the pregnancy not near its end. Tampon 
if the hemorrhage be severe, and the os not suffi- 
ciently dilated for immediate delivery ; but let the 
tampon be so applied that the hemorrhage will be 
surely stopped, and that dilatation of the os may be 
effected. Of course, a tampon can be most effectually 
applied if the perineum be drawn back by a Sims' 
speculum, and the os can be best dilated by a sponge- 
tent, or by means of Barnes's dilators, and these are 
to be preferred. 

If you use a vaginal tampon, do not soak the 
material in any astringent solution, for it is not by 
coagulating blood, but by pressure, you hope to arrest 
the flow. Of course, position is important, and you 
may also give cold acid drinks ; opium and stimulants 



244 THE PEESENT TREATMENT OF DISEASE. 

may be required if there be pain and prostration. 
Finally, turn — turn, because very often in placenta 
prsevia the foetus is transverse ; turn, because when 
you bring the legs and then the thighs into the os 
uteri, you have a most effectual tampon ; turn, 
because you can thus, as a rule, most quickly effect 
delivery ; and the great dominating principle in 
the treatment of placenta praevia is, that when the 
hemorrhage is grave, end the pregnancy as soon as 
possible, both for the safety of the mother and 
the safety of the child. 



Prof. Parvin believes that very many cases of the 
vomiting of pregnancy are due to coitus. In the 
treatment of this affection, he places at the head of 
the list tinct. nucis vomicae, gtt. ij-iij every two or 
three hours, or else gtt. x before meals. Getting 
the idea from the similar successful treatment of 
the nausea resulting from the administration of 
ether, he suggests water as hot as it can be drunk. 

Prof. Bartholow says the failure of oxalate of 
cerium in the vomiting of pregnancy is very often 
due to insufficient doses being given. Ten-grain 
doses have been given in such cases without doing 
harm. 



PREGNANCY AND PARTURITION. 245 

Dr. W. B. Atkinson offers the following conclu- 
sions, as to the treatment, in a paper read before the 
Philadelphia County Medical Society : — 

The most complete rest of body and mind ; the 
avoidance of all forms of diet save those easy of 
digestion and assimilation ; the relief of the early 
symptoms by some one of the articles mentioned 
under the head of medication ; unless prompt relief 
is obtained, the use of chloral, morphia, belladonna 
or hyoscyamus, or their combination, by the rectum 
or by the vagina. In the latter case, it is important 
that we should first carefully cleanse away the dis- 
charge usually found clinging to the os and cervix, 
and then bring the medicaments closely in contact 
with the os, and maintain them there by the usual 
methods. This failing, apply to the os and cervix, 
if need be, the glycerole of iodine or the nitrate of 
silver, and follow this by an application of the 
anodynes, as before. 

If the vomiting is now great, abandon the stomach 
as a depot for food, and employ rectal alimentation 
solely. In each injection we may include with the 
nutrient, chloral, to aid in complete rest. 

To relieve the intense thirst which is generally 
present, we may allow the patient to swallow at in- 
tervals small lumps of ice, or to drink iced carbonic 



246 THE PRESENT TREATMENT OF DISEASE. 

acid water, which is now so readily obtained from 
the siphon. Of course, just sufficient of this 
should be taken to relieve the throat at the 
moment. 

He did not consider the dire alternative of induced 
abortion, as such a procedure rarely becomes neces- 
sary. 

In regard to the hygienic management of preg- 
nancy, Prof. Parvin spoke as follows : Let the 
patient eat but little in the latter months, though 
she may eat a little frequently during the day. A 
large meal causes much inconvenience, due to the 
already enlarged abdomen. A bandage jiroperly 
applied around the abdomen is useful and com- 
fortable. She should sleep eight hours, and 
take an occasional bath in tepid water. If leu- 
corrhcea be present, let her use an injection of 
salt water, and bathe the external genitalia with 
tepid water. High-heeled shoes should be dispensed 
with during pregnancy. 

Care of the Breasts. — Use oily matters, and 
no alcohol. In the morning the nipples may be 
painted with equal parts of tinct. arnica and water, 
but in the evening should be covered with cocoa 
butter. 



PROGRESSIVE MUSCULAR ATROPHY. 247 

PROGRESSIVE MUSCULAR ATROPHY. 

Prof. Bartholow stated, in a clinical case of this 
disease, that, as regards the treatment, in the first 
place, we must, as soon as possible, resort to measures 
to stop the wasting. The muscles should be stimu- 
lated and their nutrition promoted. The first step 
consists in galvanic and faradic stimulation of the 
affected muscles ; next, injections of strychnine into 
the muscle should be practiced. In the intervals 
between the injections of strychnine, water should be 
injected, in the same way, for this expedient is found 
to promote the growth of the muscles. The dose of 
strychnine may be the one-sixtieth of a grain. 
Massage may also be employed. A judicious con- 
servatism is to be observed in the use of both 
massage and the faradic stimulus ; these applica- 
tions should not be continued too long, and the 
muscles thus fatigued. By too protracted employ- 
ment of these muscular stimuli the irritability of 
the muscles is diminished or destroyed. Their use 
should be limited to a few minutes each day. 

We must also employ measures to increase the 
nutrition of the nerve centres. The phosphates and 
lactophosphate of lime are among the most im- 
portant of the agents employed to promote the 
activity of the trophic centres. 



248 THE PRESENT TREATMENT OF DISEASE. 

In another case of this disease which had been 
preceded by rheumatism, he ordered the patient to 
take six grains of salicylate of chinoidine three times 
a day, the salicylate acting as the rheumatic element, 
while the chinoidine had a tonic effect. 

In another clinical case of this disease associated 
with syphilis, Prof. Bartholow stated that when a 
case arises, such as this one before us, of a probable 
specific character, we must take a different view of 
the causation ; for, if the local disturbance is due to 
a syphilitic lesion in the nerve, we may be able to do 
something, after the lesion has been removed, for 
the muscular wasting. When the atrophy is caused 
by disease in the nerve trunk, or is secondary to a 
central lesion, it is very different from true pro- 
gressive muscular atrophy. We take a very different 
view of the latter, as regards prognosis. 

Assuming a syphilitic history, you can find out 
whether the muscles are capable of regeneration by 
ascertaining the electrical contractility of the muscle. 
If it respond, we know that there is enough of the 
proper muscular tissue left to bring about some 
restoration of function ; if not, the muscle has wasted 
so far that nothing remains but connective tissue and 
fat. In such a condition, of course, no cure can be 
effected. Another fact : a muscle that is wasted may 



RHEUMATISM. 249 

not respond to the faradic current, but will contract 
under a galvanic current, slowly interrupted. It 
may then be restored so that it will subsequently 
respond to both currents, after the regular use of the 
constant current for a time. This shows that a 
physician needs both forms of battery, as often he 
cannot find out the state of the muscle by the faradic 
current alone ; but even when it will not contract 
at first under the induced current, the systematic 
application of the galvanic current may restore 
it to a condition where it will again react to the 
former. 



RHEUMATISM. 

Prof. Da Costa, in lecturing upon the subject 
of acute rheumatism, gave the following directions 
as to treatment : — 

No remedy has a specific action in this disease, but 
there are means which we may employ that will 
greatly lessen the after dangers. There are laid 
down two principal plans of treatment : — 

1. Salicylic Acid and the Salicylates. These are 
unquestionably the most speedy remedies, but should 
not be employed in those cases in which much weak- 
ness exists, for they greatly increase the sweats and 
depression, or in those cases where tendency to cardiac 



250 THE PRESENT TREATMENT OF DISEASE. 

complication is manifested. In these latter they 
have been stated to be worse than useless. 

If the acid be used, which is preferable to its salts, 
give not less than sixty to ninety grains in twenty- 
four hours. Ten grains may be given in emulsion 
every hour, for six hours, if borne well, and then 
the same doses may be given at intervals of two 
hours. 

If the salicylates are used, give three drachms in 
twenty-four hours. If this plan acts at all, it will 
do so promptly ; and if good results are not achieved 
by the second or third day, it had better be aban- 
doned. 

2. The Alkaline plan. This consists in rapid 
saturation with alkalies. It lessens the tendency to 
heart complication, but no good can be achieved by 
small doses ; an ounce to an ounce and a half of 
either the bicarbonate or acetate of potassium must 
be given the first twenty-four hours, half as much 
the following day, and three or four drachms each 
day thereafter. Employ until the urine becomes 
neutral or alkaline, and then diminish the dose as 
above stated. 

The bromides, which were formerly used, are not 
so rapid as the salicylates or so useful as the alkalies, 
but for lighter forms of the disease, with restlessness, 



RHEUMATISM. 251 

they can be employed with good results. They also 
have some virtue against cardiac complications. In 
weak, exhausted cases, where the weakness occurs in 
repeated attacks, use the tincture of chloride of iron. 
This remedy is preeminently useful if the case be the 
least pysemic, or of gonorrhoeal origin. In treating 
this disease, no matter what plan be adopted, it is 
always of advantage to add to the other treatment 
ten or twelve grains of quinine per day. The treat- 
ment by blisters near the joint is effective, but very 
painful. If a case be seen in which the joint remains 
involved, blister. It will always do good locally, 
and also have some good general influence. 

As to local treatment, there is not much to say. 
We may wrap the joint in lint steeped in solution of 
potassii nitras, with a little tinctura opii added, and 
cover with oiled silk. Some patients enjoy, and get 
better relief from, dry applications, enveloping the 
joint with cotton to which some powdered opium has 
been added. 

Complications. — 1. Carditis. Push the alkaline 
treatment to the utmost, supplementing by a certain 
amount of the bromides. We must give opium to 
relieve pain and procure rest and quiet. Digitalis is 
a valuable remedy, more so in endocarditis than in 
pericarditis. If seen early, use leeches locally. The 



252 THE PRESENT TREATMENT OF DISEASE. 

Germans use ice over the heart, but this, to do any 
good, must be employed early. In most cases, at the 
time when seen, relief can best be had by poultices, 
but a blister may do good. 

2. For Cerebral Symptoms, if with high tempera- 
ture, besides the general rheumatic treatment, use 
quinine to reduce the temperature. More certain is 
antipyrin : give gr. vii-x every hour until impression 
is made, but it is not advisable to go beyond gr. xxx. 
We can also use application of cold cloths to the 
abdomen, chest and limbs. Cerebral cases without 
high temperature do best on stimulus in large 
amounts, eight ounces in twenty-four hours. 



In a clinical case of inflammatory rheumatism, 
Prof. Da Costa stated that he had found the bromide 
of ammonium to diminish the tendency to cardiac 
complications. 

In a clinical case of acute rheumatism, Dr. Neff, 
at the Jefferson Medical College Hospital, prescribed 
the following : — 

Sodii salicylates, gr.xxx 

Spirit, lavand. comp., 

Syrup, simplic, aa f5ss. M. 



RHEUMATISM. 253 

When the temperature falls, which is usually on 
the second day, the alkalies are pushed for two or 
three days ; then, in the weak and anaemic, iron with 
cod-liver oil and quinine are given. 

Prof. Bartholow finds the following more efficient 
than salicylate of sodium alone : — 

xy. » 

Acid, salicylic, 5\j 

Sodii bicarb., Sj 

Aquae, fSij. M. 

SiG. — Dose, one to two teaspoon fuls. 



In a case of acute rheumatism, complicated with 
organic disease of the heart, Dr. James C. Wilson, 
Physician to the Jefferson Medical College Hospital, 
said : — 

The point in treatment is this, in almost all severe 
cases and in many mild cases of acute articular 
rheumatism : if auscultation is carefully practiced, 
there will be found, at some period of the disease, 
without other changes, a systolic blowing murmur 
which is not heard over the apex. This is often 
faint and easily overlooked. The changes in the 
valves consist of infiltration of the sub-serous tissue 
of the leaflets with inflammatory products, which give 
rise to such conditions as prevent close approxima- 
tion of the edges of the leaflets, and thus allow 



254 THE PRESENT TREATMENT OF DISEASE. 

regurgitation. If the patient be kept on the back, 
so that the number of revolutions of the heart be 
kept down to the minimum, and the amount of 
strain on the leaflets made as slight as possible, and 
the intervals between the tensive process be pro- 
longed so that the valve has a greater opportunity 
for physiological rest, the reparative processes will be 
facilitated and more or less complete restoration of 
the valve be effected. 

A patient with acute articular rheumatism must 
be kept on his back. He must not be permitted to 
get up as soon as the evidences of joint inflammation 
have disappeared, particularly if there have been any 
signs of endocarditis. If there have been the slightest 
evidence of endocarditis — nay, to go further — even 
if there have been no signs of endocarditis, you will, 
if you do your best for the patient, prolong the rest 
in bed for a considerable time — a week or ten days, at 
least, after the disappearance of the symptoms. If, 
on the other hand, the patient is allowed to get up 
while the heart is weak, while the tissues of the 
valve-leaflets are infiltrated with inflammatory pro- 
ducts, an increased amount of activity will be brought 
upon the heart and its valves in their damaged con- 
dition, the time of physiological rest will be shortened 
and the pressure will be increased. In this way he 



RHEUMATISM. 255 

believed that permanent lesions which could be 
averted by continued rest are produced in hearts but 
slightly damaged by the primary trouble. 

The treatment in this case had been a pill of ergot, 
iron and digitalis. Its use had been followed by 
improvement, and was accordingly continued. 

See Endocarditis (Heart, Diseases of). 



In a case of acute rheumatism affecting a special 
muscle — the masseter — Prof. Da Costa, at the Penn- 
sylvania Hospital, said : — 

The only thing done in the way of treatment was 
to administer hypodermic injections, into the affected 
muscles, of solutions of atropine and morphine, from 
which such good results had already been obtained 
in the treatment of spasmodic wry-neck. Under 
these the disease was rapidly yielding. The patient 
received one-sixtieth of a grain of atropine and one- 
sixth of a grain of morphine once a day. He had 
had only two hypodermic injections, but he had 
begun to improve. Dryness of the throat he had 
not complained of, but his pupils were seen to be a 
little dilated. No effect upon the pulse had been 
shown. The dose was increased to one-fiftieth of a 
grain of atropine, accompanied by one-sixth of mor- 
phine, which, to some extent, counteracted the effects 



256 THE PEESENT TKEATMENT OF DISEASE. 

of the former. This constituted the local treatment ; 
while, to remove the rheumatic element, he would 
order salicylate of sodium, fifteen grains every three 
hours, until he took six doses, so that he could 
take daily one drachm and a half. It could be 
mixed with a little spirit of lavender and mint 
water : — 

i 

Ij, 

Sodii salicylatis, gr.xv 

Spirit, lavandulse comp., gtt.x 

Elixir, aurantii, gtt.xxx 

Aquae menthse pip., f5j, gtt.xx 

Pulv. acacise, gr.j. M. 

SiG. — To be taken every three hours until six doses 
have been taken in the day. 

Continue the hypodermic injections. 



Prof. Bartholow says the suggestion to apply oleum 
gaultherise locally in rheumatism is to be much 
commended. If the skin will not bear it, it may be 
diluted in soap liniment : — 

Olei gaultherise, Sj 

Linimenti saponis, §iij. M. 

In the clinic, he had frequently prescribed it in 
rheumatism with excellent results. A useful com- 
bination for internal use is — 



EHEUMATISM. 257 

3, 

01. gaultheriae, 5j 

Acidi salicylici, 3iv 

Sodii biborat., 5j 

Syrup, picis liquidse, 

Aquae anisi, aa f5ij. M. 

Sig. — Dessertspoonful every four hours. 

Prof. Bartholow stated, in a clinical case of rheu- 
matism, that, by all means, the best alkali in the 
treatment of rheumatic affections is the bromide of 
lithium. 



For a clinical case of chronic rheumatism in an 
anaemic woman, in whom the joints of both hands 
were stiff and swollen, together with the large joints 
of the body, Dr. J. C. Wilson prescribed, at the 
Jefferson Medical College Hospital, ol. morrhuse, 
gss, bis die ; flannels to be worn next the skin, and — 

Mist, ferri et ammonii acetat., fBss 

Strychninse sulphat., gr^V 

Sig. — To be taken ter die, after meals. 



Prof. Da Costa directed, in a case of rheumatoid 
arthritis affecting the second joints of the fingers 
alone, that passive motion should be performed after 
soaking the parts in hot water in which was dissolved 
a little sal soda ; and internally gtt. xx of the syrup 



17 



258 THE PEESENT TKEATMENT OF DISEASE, 

of the iodide of iron ter die, the dose to be slowly 
increased to one drachm. 



RHEUMATISM, GONORRHEAL. See Gonorrhoea. 



RHINITIS. SeeCoryza. 



ROSE COLD. See Hay Fever. 



SAINT VITUS'S DANCE. See Chorea. 



SCARLET FEVER. 

When lecturing upon scarlet fever, Prof. Da Costa, 
at Jefferson Medical College, mentioned the follow- 
ing agents as being of use : — 

1. Carbolic acid, gtt. £, a dose for a child two 
years old. Give in mint water. 

2. Ammonium carbonate, gr. ij, every two hours, 
to child ten years. 

3. Potassium chlorate, 5j, in water, Oj. Patient 
to drink this in twenty-four hours. 

4. Salicylic acid when high temperature is present. 
. 5. Small doses of chloral. 

Always keep skin active, and if heart be weak, 
give digitalis ; if arterial tension be high, give 
aconite. 



SCIATICA. 259 

When much exudation has occurred, he prescribed, 
for its solvent action — 

Ammonii carb., gr.x 

Liquor, ammon. acetat., f§ss. M. 

Sig. — Every four hours. 

If there is much depression, prescribe, also, quinia 
and digitalis in combination. 

For the past few years he had been using boracic 
acid, glycerine and water, as a gargle in scarlatina, 
and he considered it an admirable gargle. 



SCIATICA. 

In a clinical case of sciatica due to joint changes, 
Prof. Bartholow said : The first thing to be done is 
to relieve pain in these nerve trunks. Deep injection 
of chloroform will give much relief; alcohol and 
ether may be used for the same purpose. Can we 
also give remedies to check the progress of the 
disease in the joints? Although the state of the 
joint is not altogether satisfactory, we can do little to 
influence it directly, but we can influence its relation 
to the system so as to bring about a state of affairs 
altogether different. The bromide of lithium, or the 
iodide of ammonium, kept up steadily for a long 
time, with cod-liver oil for months without inter- 



260 THE PRESENT TREATMENT OF DISEASE. 

mission, and the hypodermic injection of chloroform 
or ether, will relieve the symptoms to a marked 
extent. 

SCLEROSIS, POSTERIOR SPINAL (Locomotor Ataxia). 

In a case of incipient locomotor ataxia,* Prof. 
Bartholow stated that the metallic tonics, so to speak, 
are the drugs that we will derive the most benefit 
from in this disease. Prominently among this class 
he would place nitrate of silver, which, when per- 
sistently used, is eminently calculated to cure, or at 
least to control, its progress. He would also mention 
chloride of gold and sodium, which is at least as 
efficacious as nitrate of silver, if not more so. 

Syphilis is a very common cause of locomotor 
ataxia ; indeed, some authorities go so far as to say 
that the disease is always caused by syphilis. It 
would seem, as some suppose, that while the disease 
is not directly caused by syphilis, yet it may be, so 
to speak, evolved from it. While locomotor ataxia is 
not a symptom of active, acute syphilis, yet the 
specific affection may cause such changes in the 
nervous system as to favor the development of the 
disease, so that the disease may be said to be induced 
or favored by syphilis, which must be recognized as 
a potent factor in very many cases. 

* Reported in the Peoria Medical Monthly. 



POSTERIOR SPINAL SCLEROSIS. 261 

This question will have an important bearing on 
our therapeutics. If we know that there be a specific 
taint, and especially if the disease be of recent date, 
it is obvious that we would resort to iodide of potas- 
sium. In this case we can get no direct history of 
syphilis as a causative influence, but in general 
terms, when the existence of a specific influence is 
suspected, it would be good therapeutics to use the 
iodide. 

He would order the nitrate of silver in pill form 
in this case. It has the property of accumulating in 
the system when used for a long time, and producing 
very unpleasant results ; yet, that it may do good, it 
must be used for a long time. Hence, he would give 
directions, by observance of which its use may be 
long continued, without deleterious effects. The 
patient should take it continuously for six weeks 
and then suspend its use, being then thoroughly 
purged, and other measures resorted to in order that 
the accumulated drug may be removed from his body 
by means of the excretory organs. After an interval 
of two weeks he should recommence the drug, con- 
tinue it again for six weeks, suspend it, eliminate it 
as before, and so on. By thus cautiously handling 
the drug, it may be persisted in for so long even as 
two years, but all this caution is imperatively needed. 



262 THE PRESENT TREATMENT OF DISEASE. 

The electric brush has been highly lauded by 
some authorities, and its use will be frequently pro- 
ductive of very good results. Strumpf, of Dussel- 
dorf, has had remarkable success in the treatment of 
locomotor ataxia by general cutaneous faradization. 
The method consists in passing through the skin of 
the whole body a mild current — not strong enough 
to cause muscular action — by placing the feet on a 
copper plate connected with one of the poles, and 
moving the other electrode over the surface generally. 
Or the procedure may be reversed — one of the poles 
placed on the neck, and the other passed over the 
body generally. If rightly applied as to the strength 
of the current, no pain or other disagreeable sensa- 
tion is produced. 

The length of the application thus made should 
be about ten to fifteen minutes — not long enough 
to cause a feeling of fatigue. Some authorities claim 
that they have arrested the disease in many cases by 
the use of the electric brush alone, without other 
remedies. Whether this is true or not, Prof. Bar- 
tholow was not prepared to state, though a compara- 
tively small amount of positive evidence in this, as 
in any other direction, will outweigh a much greater 
amount of negative evidence, and he was quite sure 
that its effects are sufficiently good to warrant us in 



POSTERIOR SPINAL SCLEROSIS. 263 

giving it a very thorough trial in every case we have 
to treat, 

It is a common mistake that is made by the gen- 
eral practitioner who has not an intimate acquaint- 
ance with the therapeutic uses of electricity, to 
employ it in too strong quantities. He would lay 
down the rule that electricity should be used in 
such quantity only as will produce a pleasant sensa- 
tion, an agreeable titillation. The very strong cur- 
rent will prove injurious, while the weak current, 
directly acting on the skin only, and not pro- 
ducing pain, but only pleasant feelings, will surely 
do good. 

Some authorities say that the patient should be 
kept in bed for a month or more at a time. While 
he should have rest, yet a certain amount of 
exercise is beneficial, but not carried to fatigue, for 
then it will prove very injurious. When we enjoin 
rest, we must caution the patient to be very careful 
not to eat to excess, and, indeed, the diet must be 
materially reduced. From each individual case we 
must draw the indications for the kind of restriction 
we will impose upon the diet. If the patient suffers 
from indigestion at all, we must inquire into its 
nature, and expel from the dietary the offending 
articles. Thus, if he has acid indigestion, we must 



264 THE PKESENT TREATMENT OF DISEASE. 

exclude the fats, which, by fermentation, generate 
butyric acid. 

In another case, Prof. Bartholow, for the improve- 
ment of the nutrition of the spinal cord, gave the 
patient phosphorized cod-liver oil (gr. tfo- of phos- 
phorus in fBss of the oil) thrice daily. 



In a case of locomotor ataxia, where the patient 
had been pretty thoroughly saturated with silver, 
Prof. Da Costa, to tone up the system, gave — 

^. 

Strychninse, g r «^V 

Syrup, hypophosphit., f5j. M. 

Sig. — Ter die. 

He thinks that one of the most efficient remedies 
for the severe pains of this disease is hyoscyamine, 
gr. 2T7, every night, to be increased to double 
the amount. 



For a case of beginning cerebro-spinal sclerosis 
Prof. Bartholow directed the following : — 

Auri et sodii chlorid., g r -T$ 

Hydrarg. chlorid. corrosiv., g r -iV M. 

Ft. pil. 
Sig. — Ter die ; 



scurvy. 265 

and one minim of oleum phosphoratum, well diluted, 
after meals. 



The following was prescribed by Dr. J. Solis- 
Cohen for a woman sixty-eight years old, whose 
case was diagnosed as disseminated sclerosis : — 

9- 



M. 



Aurii et sodii chlor., 




Hydrarg. bichloridi, 




Arsenici iodidi, aa 


g r -j 


Extract, cinchonae, 


q.s. 


Fiant pil. xx. 




Sig. — One after meals. 





SCURVY. 

Two cases of scurvy in sailors were shown at the 
Pennsylvania Hospital clinic by Prof. Da Costa. 
They were given dilute muriatic acid, gtt. v, ter die ; 
juice of three lemons daily ; vegetables and fresh 
meats. Their teeth becoming loose, the gums were 
painted with tincture of iodine. Later, for fetor of 
breath and for the teeth, the following was advised : — 

!$«. 

Thymol, gr.ij 

Acid, boracic, gr.v 

Glycerini, f5j 

Aquae, ad fBj. M. 

Sig. — Gargle. 



266 THE PRESENT TREATMENT OF DISEASE. 

SEA-SICKNESS. 

Prof. Bartholow considers the most efficient reme- 
dies in the treatment of sea-sickness are chloral and 
potassium bromide. Their administration should 
begin before the cause. 



SKIN DISEASES. 

In a case of eczema of the hand, Prof. Bartholow 
stated that the remedies appropriate in erysipelas are 
applicable to this disease. He directed three grains 
of sulphate of quinine with one-fourth of a grain of 
extract of belladonna, three times a day. The 
amount of belladonna may be increased, if neces- 
sary, but the dose indicated will probably be sufficient 
to obtain its constitutional effect. Unless we procure 
some decided effect, we shall probably fail to arrest 
the malady. Attention to diet and to the state of the 
different functions is also of importance. 

As regards local treatment, he directed the part to 
be dusted with subcarbonate of bismuth. This will 
allay the irritation and diminish the irritability of 
the end organs of the sensory nerves. Further 
development of the affection may, of course, necessi- 
tate the use of other remedies. 

He thought that a strict vegetable diet would 
often cure eczema when all other means failed. 



SKIN DISEASES. 267 

A case of chronic eczema, of seventeen years' 
standing, was treated by Dr. J. V. Shoemaker as 
follows : — 

Antimon. et pot. tart., g r «A- 

Ext. gentian, gr.ij 

Aloin, g r «xV» M. 

Ft. pil. 
Sig. — Ter die. 

Also — 

3, 

Naphthal. 5ss 

Camphorae, 5ss 

Ung. hydrarg. nitrat., 5ij 

Ung. zinci oxid., q.s. ad §iss. M. 
Ft. ung. 
Sig. — Apply to surface, twice daily. 



Prof. Parvin uses as a local application in eczema 
of the vulva the following : — 

1*. 

Plurabi acet., 5j 

Acid, hydrocyan. dil., f5\j 

Aquae, fSiij- M. 

Sig. — Apply to the parts every three or four hours ; less 
often if the skin is broken. 



Prof. Bartholow, for a case of erythema nodosum, 
in a girl twelve years old, prescribed — 



268 THE PRESENT TREATMENT OF DISEASE. 

Sodii phosphatis, 5j. 

Sig. — Ter die, in hot water before meals. 

H. 

Mangani sulph., gr.ij 

Quininse sulph., gr.ij 

Ferri arsenitis, g r TV ^' 

Ft. pil. 
Sig. — This pill after each meal. 



Prof. Da Costa directed, in a case of favus of the 
scalp of ten years' duration, that the mass of crusts 
be softened and removed with this solution : — 

Liquor, potassse, f^ss 

Glycerini, fgss 

Aquae, f^iij. M. 

Sig. — Put on as a fomentation. 

Then, as a germicide, to cure the disease, apply 
corrosive sublimate, four grains to the ounce, twice 
daily, to the parts affected. 



Prof. Bartholow prescribed in a clinical case of 
herpes annularis — 

Syrup, calcii lactophosphat., f§iv 

Liquoris potass, arsenitis, f5j. M. 

Sig. — Teaspoonful three times a day. 



SKIN DISEASES. 269 

Apply locally a five per cent, solution of pyrogallic 
acid, after preparing the surface with a poultice and 
cleansing. 

For a case of ichthyosis occurring in a boy aged 
twelve, Prof. Bartholow prescribed — 

Saponis mollis, §iij 

Ol. cadini, gj. M. 

Sig. — Rub it into the skin thoroughly at night, after the 
removal of the scales. 

He was also given twice daily a gtt. xv. of ext. 
pilocarpi fluid. 

The dose to be increased until the full physiologi- 
cal effects are obtained. 



Prof. Bartholow says that itching of the skin, from 
any cause, can be allayed by sponging the patient 
with — - 

Acid, carbol., 5ij 

Glycerin i, §j 

Aquse rosse, ad Sviij. M. 

Sig. — Lotion. 



Prof. Bartholow uses an ointment of picrotoxin, 
gr. x, to benzoinated mutton suet, Sj, in parasitic 
shin diseases. 



270 THE PRESENT TREATMENT OF DISEASE. 

Prof. Parvin treated a case of general pruritus 
successfully by putting the patient on an absolute 
milk diet, and giving Fowler's solution, gtt. vij ter 
die. 

Prof. Brinton has, for many years, treated, with 
excellent results, pruritus ani with teucrium scor- 
dium, in gr. xv-xx doses, ter die, in water. It is to 
be used for four or five days, until effects are pro- 
duced. 

Prof. William Goodell recommends for pruritus 
vulvce — 
Ify. 



Acid, carbolic, 


3j 


Morphinae sulpha tis, 


gr.x 


Acid, boracic, 


38 


Vaseline, 


Sij. 



M. 

Also, pat the parts with a sponge soaked in boiling 
hot water. This is also a most excellent application 
for that rawness so often found between the thighs 
of the newly born. 



For a case of psoriasis, Prof. Da Costa advised 
the persistent use of the following : — 

s- .■.,'..■ . 

Acidi arseniosi, g r -Tir 

Capsici, gr.J. M. 

Sig. — Ter die. 



9- 




Potassii carb., 


5j 


Aquse, 


•Oij. 


Sig. — Apply frequently. 





SKIN DISEASES. 271 

As a morning laxative Rochelle salt, 5ij. The 
diet must be varied, consisting chiefly of fruits and 
vegetables. No salt meats, The local treatment : 
Get rid of the scales by a poultice, then use — 



M. 



In a case of chronic psoriasis of eleven years' 
duration, and which had during this time baffled all 
treatment, he placed the patient, a young man of 
twenty-two years, on Donovan's solution, gtt. x ter 
die, to be increased to gtt. xx ter die ; the object 
being to produce the full physiological action of the 
remedy. 

In a clinical case of acute psoriasis, Dr. Morris 
Longstreth said that the remedies usually directed 
to the treatment of psoriasis in its chronic stage, — 
arsenic, for instance, — at that period would be inad- 
missible. The patient was, in view of its recent 
appearance, ordered alkaline baths, and placed upon 
a plain, unstimulating diet, with proper attention to 
the secretions ; and as a result the red, inflamed 
appearance of the arms, and afterward of the legs 
and the back, rapidly faded away. Then the disease 
assumed the chronic form, and about the first of the 



272 THE PRESENT TREATMENT OF DISEASE. 

year, or four weeks after the commencement of the 
disease, he was given the special treatment by arsenic 
(sodium arseniate, gr. ^V every four hours), and since 
then the improvement has been far more rapid and 
decided than it was before. 



Prof. Da Costa prescribed with perfect success the 
fluid extract of ergot, gtt. x ter die, in a case of 
purpura. 



SMALL POX. 

The treatment of small pox, as given by Prof. 
Da Costa, is as follows : — General treatment. Cool 
room ; sponge body ; light food ; when suppuration 
sets in, support patient with egg-nog, milk punch, etc. 
Carbolic acid, gr. i-ss, in mint water, every two 
hours, or xylol, gtt. x, in capsules, every two hours, as 
used in the Berlin Military Hospital. For the general 
debility, tinct. iron and quinine. In early stage 
of fever, aconite or digitalis, as indicated by pulse. 
For the secondary fever, quinine, gr. xii-xvj, daily, 
in conjunction with iron. When delirium is present, 
use morphine or camphor with opium. Chloral also 
has been of value. For diarrhoea, sulphuric acid 
with opium. For ulceration of cornea, touch with 
silver nitrate. Local treatment, — dark room ; lauda- 



SPEUMATOEKHCEA. 273 

num and water for itching. One of the most efficient 
means of preventing the " pitting " of small pox is 
by the application of — 

Hydrarg. chloridi corrosivi, gr.j 

Aquae, fSiij. M. 

Sig. — Apply by means of a camel's-hair brush. 



SPERMATORRHOEA. 

Prof. Gross offers the following general remarks 
on the treatment of this disease* : — 

In all cases of seminal incontinence, with rare 
exceptions, the remedies at the onset should be 
directed to overcoming the sensibility of the mucous 
membrane of the urethra, of the ejaculatory ducts, 
and of the seminal vesicles ; to subduing the irri- 
tability of the muscles concerned in ejaculation; and 
to diminishing the reflex excitability of the genito- 
spinal centre. Hence, they should be of a calming 
and sedative nature. By the ignorant and indis- 
criminate employment of strychnia, cantharides, 
phosphorus, damiana, and cold sitz-baths or affusions 
during the stage of hyperesthesia, much harm is 
done, and the therapeutics of spermatorrhoea brought 
into disrepute. 

Premising the statement that tonic should follow 

* Practical Treatise on Impotence and Sterility. Phila., 1881. 
18 



274 THE PRESENT TREATMENT OF DISEASE. 

the sedative plan of treatment, I will now give an 
outline of my view as to the best management of the 
varieties of the affection : — 

Under all circumstances thirty grains of bromide 
of potassium, along with about ten drops of the 
fluid extract of gelsemium (Bartholow) every eight 
hours, and one-sixtieth of a grain of sulphate of 
atropia (Rosenthal) on retiring, are worth all the 
other internal remedies combined. In anaemic sub- 
jects the bromide may be administered at night and 
quinine and iron be exhibited during the day ; but 
if the bromide be badly borne, it should be guarded 
(or its cumulative action must be prevented) by pro- 
moting its excretion by the urine, combining it with 
a diuretic, as ten grains of nitrate or bitartrate 
of potassa (Rosenthal). This combination is far 
better than that with Fowler's solution (which is 
advised by Gowers and Bartholow), or it may be 
replaced by twenty grains of chloral. Not only 
does atropia diminish reflex mobility of the genito- 
spinal centre, but the recent researches of Kenchel, 
Heidenhain, and Strieker and Spiner show that it 
paralyzes the movements of the cells of the acinous 
glands and checks their secretion, so that it cannot 
be dispensed with. 



SPRAINS. 275 

Prof. Bartholow states that he has had better 
results from the combination of potassium bromide 
and digitalis in the spermatorrhoea of plethora, than 
from any other remedies. In spermatorrhoea of the 
pathological type, he gave, at the clinic — 

Extract, ergotaa fluid., 

Extract, pilocarpi fluid., aa gtt.xv. M. 

Sig. — Bis die, morning and night. 

Also — 

Auri et sodii chloridi, g r «inj" 

Extract, nucis vomicae, g r 'i« M. 

Fiat pil. 
Sig. — One ter die. 

Excellent results might also be obtained by passing 

an interrupted galvanic current through an insulated 

electrode placed in the urethra, the exposed part 

being in the prostatic urethra, the other electrode to 

be placed upon the perineum. 



SPINAL SCLEROSIS (POSTERIOR). See Sclerosis. 



SPRAINS. 

For sprains, Prof. J. H. Brinton teaches that the 
limb is to be put into a vessel of very hot water 
immediately, boiling water being added as it can be 
borne, and kept immersed for twenty minutes or 



276 THE PRESENT TREATMENT OF DISEASE. 

until the pain ceases. Then put on a pretty tight 
bandage and order rest. Sometimes the joint can be 
used in twelve hours. If the trouble is more chronic, 
apply a silicate of sodium dressing, and let the 
patient walk with a cane, if the ankle be the joint 
affected. 



STOMACH, DISEASES OF. 

When the stomach is irritable, so that medicines 
cannot be retained, and if it should be necessary to 
purge the patient, Prof. Gross recommends the fol- 
lowing injection, should there also be much tympany: 
Oil of turpentine, Sss, rubbed up with the yelk of 
one egg y then add castor oil, giss, warm water, Oj. 
To be used as an injection. 



Prof. Bartholow is opposed to the use of the 
soluble salts of bismuth. In the various dis- 
orders for which the insoluble salts are prescribed, 
especially in the stomachal diseases, he prefers this 
combination : — 

9. 

Bismuthi subcarb., $j 

Creasoti, gtt.j 

Glycerini, 

Aquae, aa £5ss. M. 

Sig.— Take diluted. 



SUNSTROKE. 277 

Prof. Da Costa prescribed the following treatment 
for dilatation of the stomach : Dry solid food ; under- 
done meats ; no milk. Give carbolic acid to allay 
fermentation ; wash out the stomach occasionally ; 
administer strychnia, hypodermically or by the 
mouth. 

(See Cancer, Gastralgia, Gastric Ulcer, Gastritis, 
etc.) 



SUNSTROKE. 

For the treatment of sunstroke, Prof. Da Costa 
prescribes the following : — 

For heat exhaustion, removal to a cool place, 
stimulation and forced feeding. For sunstroke proper, 
or thermic fever, reduce the temperature by stripping 
patient and dousing with cold water, or rub down 
with ice. A new method, introduced into practice 
simultaneously by some New York physicians and 
by Dr. Orville Horwitz of Philadelphia, is the use of 
antipyrine, either hypodermically, per rectum or by 
the mouth. This plan has given excellent results. 
Turpentine by the bowel, at times, is useful. When 
the face is flushed, pulse full, put a drop or two of 
croton oil on the tongue. The use of the lancet is 
not advised, but exceptionally, when the case simu- 
lates apoplexy, it may be called for. Dry cups to 



278 THE PRESENT TREATMENT OF DISEASE. 

the back of the neck in these cases do good. See 
that the kidneys keep acting ; keep the system full 
of liquids ; give water by the rectum. For convul- 
sive phenomena, asafcetida by the bowel, inhalations 
of chloroform, with care, and chloral hypodermically, 
all do good ; but the most certain is morphia, thrown 
under the skin. 

When the acute symptoms are over, a long treat- 
ment is necessary. If the patient has means, he 
should remove to a cool climate, at least during the 
summer, and do no work of any nature for a year. 
Care must be taken about the function of the bladder, 
as irritability of that organ remains, also severe 
headache. Both of these troubles, are best relieved 
by potassium bromide and cannabis indica. 



SURGICAL FEVER. 

Prof. Gross recommends as a cathartic in surgical 
fever with constipation, coated tongue and nausea, 
this powder : — 

Hydrarg. chlorid. mit., gr.v 

Ipecac, pulv., 

Capsici pulv., aa gr.ss. M. 



A mixture used at the Jefferson Medical College 
Hospital, in surgical fever, is the following : — 



SYPHILIS. 279 

I^i. 

Liq. ammon. acetat., 
Liq. potass, citrat., aa f5j 

Spirit. a3th. nit., 

Liq. morph. sulph., aa fgss. M. 

Sig. — Dessertspoonful ter die. 

If the fever runs very high, gtt. ij tinct. aconit. 
rad. are added to each dose. 



SYPHILIS. (See also Chancroid.) 

Prof. Gross strongly cautions against telling a 
man with a history of any kind of a sore on his 
penis that he does not have syphilis, until three 
months have elapsed from the last connection. The 
sore may not be a chancre, but a chancre may be 
incubating. 

He ordered for an infant one year old, suffering 
with inherited syphilis, the biniodide of mercury, 
gr. t$, and potassium iodide, gr. I, ter die ; this to 
be gradually increased. For the eruption : — 

Unguent, hydrargyri, 

Unguent, zinci oxidi, aa §ss 

Balsami peruviani, 5j. M. 

The mucous patches to be brushed over every 
second day with a thirty-grain solution of argent, 
nitras. 



278 THE PRESENT TREATMENT OF DISEASE. 

the back of the neck in these cases do good. See 
that the kidneys keep acting ; keep the system full 
of liquids ; give water by the rectum. For convul- 
sive phenomena, asafcetida by the bowel, inhalations 
of chloroform, with care, and chloral hypodermically, 
all do good ; but the most certain is morphia, thrown 
under the skin. 

When the acute symptoms are over, a long treat- 
ment is necessary. If the patient has means, he 
should remove to a cool climate, at least during the 
summer, and do no work of any nature for a year. 
Care must be taken about the function of the bladder, 
as irritability of that organ remains, also severe 
headache. Both of these troubles, are best relieved 
by potassium bromide and cannabis indica. 



SURGICAL FEVER. 

Prof. Gross recommends as a cathartic in surgical 
fever with constipation, coated tongue and nausea, 
this powder : — 

Hydrarg. chlorid. mit., gr.v 

Ipecac, pulv., 

Capsici pulv., aa gr.ss. M. 



A mixture used at the Jefferson Medical College 
Hospital, in surgical fever, is the following : — 



SYPHILIS. 281 

should be given as soon as the odor of the breath 
gives warning of the commencement of ptyalism. 

He warns against the use of iron in the later 
stages of syphilis, when we have to deal with de- 
posits, for it tends to render them permanent and 
prevent their destruction. 



In a case of inherited syphilis, in a girl eleven 
years of age, in which a gumma was the prominent 
syphilitic symptom, Prof. Gross cautioned against 
opening a gumma, no matter how soft it may appear. 
It would only make a fistulous opening, difficult to 
heal. Endeavor, on the contrary, to obtain absorp- 
tion. Place the hand and arm upon a padded 
splint, and keep it quiet. Subsequently, we usually 
paint the surface with iodine diluted with an equal 
amount of alcohol, and applied every eight hours. 
But the internal treatment is, of all others, iodide 
of potassium ; it acts almost like magic. These 
tumors may be so soft that they seem to be on the 
point of opening, and yet they may be entirely 
absorbed by this treatment. The iodide is certainly 
the best of all remedies for producing a temporary 
effect upon the tertiary lesions of syphilis, but it 
does not effect a permanent cure : the influence is not 
sufficiently lasting. 



282 THE PKESENT TKEATMENT OF DISEASE. 

The disease is ultimately sure to break out again, 
unless you put the patient on the mixed or mercurial 
treatment. He would order potassii iodidi, gr. iv ; 
hydrarg. chlor. corrosiv., gr. 3V, to be taken in syrup 
of red orange or simple syrup, three times a day. 
This is all the treatment that will be required. We 
might have given the iodide by the stomach, and 
used the mercury by inunction, in the form of the 
oleate, but this is a dirty and troublesome mode of 
treatment, and one that is not especially required in 
this case. 

When a syphilitic patient cannot take potassium 
iodide, he gives — 

1*. 

Tinct. iodi, gtt.vj 

Syrupi aurantii, f5j 

Aquae, q.s. ad f§j. M. 

Sig. — Ter die. 



In a clinical case of cerebral syphilis, accompanied 
with hemiplegia, Prof. Da Costa placed the patient 
on light but nourishing diet, without stimulants, and 
directed him to keep quiet in bed, and not to make 
any great exertion, so that the nourishment of the 
brain might be kept up, and no strain put upon it, 
for the vessels might readily rupture in this condi- 



SYPHILIS. 283 

tion. Endeavor to prevent cerebral fullness by pro- 
hibiting stimulants or over-feeding; so, of course, insist 
upon bodily rest. The patient should take laxa- 
tives from time to time, which would aid in preventing 
cerebral fullness. He would continue the treatment 
of the syphilis by iodide of potassium in decided 
doses, twenty grains thrice daily, to be gradually 
increased, and electricity to keep up the nutrition of 
the paralyzed muscles. Faradization with weak 
currents, and in a few days alternating with the 
continuous, will aid recovery, but the main point is 
the treatment of the syphilitic endarteritis and the 
absorption of the plug. In the meantime he would 
carefully maintain the supply of healthy blood, to 
remedy the impaired nutrition of the brain which 
these changes are so apt to induce. 

Prof. Bartholow speaks highly of the use of ethyl 
iodide by inhalation, when a prompt iodine impression 
is desired, as in syphilis of the brain. 



For a case of secondary syphilis, with very marked 
symptoms, Prof. Da Costa ordered — 

Hydrarg. iodid. virid., gr.^ 

Extract, conii, gr.j. M. 

Sig. — Pushed till gums are touched. 



284 THE PRESENT TREATMENT OF DISEASE. 

Prof. Gross thus epitomizes the treatment of sec- 
ondary syphilis : Mercury is the only remedy that 
should be given in this stage ; do not give it in the 
first stage, for no one can be cured of syphilis who 
has not suffered from some of the secondary symp- 
toms. The prognosis is less favorable in the tuber- 
cular form of eruption than the erythematous. Any 
form of mercury can be used, according to the in- 
clination of the doctor ; the protiodide is one of the 
best. Combine with it some article to act on the 
skin, and some opium to prevent its running off from 
the bowels : — 

Hydrargyri iodidi viridis, gr.i 

Antimonii et potass, tartrat., 

Morphinse sulph., aa g^V ^' 

Fiat pil. 
Sig. — Begin with one after each meal, increase the noon 
dose one pill every two days until the gums are 
touched, then diminish and keep at a dose easily 
borne by the patient. 

Do not salivate. Patient should have a good 
nourishing diet, and should take a warm bath every 
other day. This treatment should be kept up for 
three years, with intermissions, as a rule. During 
this time all the symptoms will disappear, with only 
an occasional return of a mucous patch. To insure 



SYPHILIS. 285 

a cure, continue treatment for one year after all 
symptoms have disappeared. 



For the local treatment of squamous syphilides, 
Prof. Gross recommends the following elegant pre- 
scription : — 

Hydrarg. bichlorid., gr.iv 

Tinct. benzoini, fSss 

Aquae cologniensis, fSj 

Aquse rosse, fSivss. M. 

Sig. — Apply with sponge, and hold in contact with the 
skin for twenty minutes. 



A child twenty months old, suffering with dactyl- 
itis syphilitica, and other evidences of hereditary 
syphilis, was treated by Prof. Brinton with the fol- 
lowing combination : — 

Hydrarg. chlor. corros., g r -7T 

Potas. iodid., gr.j. M. 

Ft. pil. 
Sig. — To be taken ter die. 



Prof. Bartholow prescribed, in a case of tertiary 
syphilis — 

>• 

Hydrarg. iodidi viridis, 

Extract, belladonna?, aa gr.£. M. 

Sig. — Ter die. 
If this makes the bowels too loose, add opium. 



286 THE PRESENT TREATMENT OF DISEASE. 

Several times, at his clinic, Prof. Brinton has 
given the following combination in cases of tertiary- 
syphilis : — 

Iodi, 38 

Hydrarg. chlor. corrosiv., gr.ij 

Potassii iodidi, 5»j 

Aquse, f§iij» M. 
Sig. — f5j ter die. 

In a case of malignant precocious syphilis in a 
woman, in which secondary symptoms were inter- 
mixed with tertiary manifestations, Prof. Gross said 
the treatment should be very thorough. The woman 
had iritis, which came on at this early period. In 
such a case, a solution of atropia (gr. iv to 5j) should 
be instilled three or four times a day ; not only does 
this prevent the formation of inflammatory adhesions 
between the lens and iris, by fully dilating the pupil, 
but if any have been recently formed, it tears them 
asunder; the atropia has also a decidedly sedative 
action upon the vessels and nerves of the eye. The 
case should also be brought under the influence of 
mercury as promptly as possible, in order to arrest 
the progress of the iritis, and prevent further struct- 
ural changes in the eye. The patient is pale, weak, 
and pretty well broken down, but notwithstanding 



SYPHILIS. 287 

this, she should be put upon a mercurial course, in 
combination with tonics : — 

Quininse sulphat., gr.ij 

Ferri sulphat., gr.j 

Hydrarg. chlorid. mitis, gr.j 

Opii, gr.ss. M. 
Ft. pil. 
Sig. — To be taken three times daily. 

She should have the best possible diet, including 
four good milk punches in the twenty-four hours, 
made with the best brandy, of which she shall get 
about four to six ounces daily. 

For the mucous patches and ulcers in the throat, 
local applications should be made, every day, of the 
acid nitrate of mercury diluted with twelve parts of 
water, and she may use a simple gargle of water. 
To relieve the pain about the orbit, which is more 
severe at night when she gets warm in bed, she may 
take — 

Pulv. ipecacuanha? comp., gr.x 

Morphine sulphatis, gr.^. M. 

in two pills at night. This will give her the equiva- 
lent of two grains of opium. 

She must not be salivated. We only wish to 
make a gentle mercurial impression, and will then 



288 THE PEESENT TREATMENT OF DISEASE. 

put her on the mixed treatment (gr. x iodide of 
potassium ; gr. tV bichloride of mercury, three times 
in twenty-four hours). At the same time she shall 
steadily keep up the tonics, iron and quinine. We 
cannot in such cases dispense with tonics ; if we 
were compelled to make a choice of the remedies, we 
would rather rely upon the milk punch and tonics 
than upon mercury, but still we regard the mercury 
as almost indispensable. 



T^MIA. See Tapeworm. 



TAPEWORM. 

At the clinic, Prof. Da Costa reported a private 
case of taenia, in which one hundred and twenty feet 
of worm were passed. No food, calomel, pelletierine 
and a purgative, in the order given, still prove uni- 
formly successful in the treatment of tapeworm. He 
considers pelletierine, the active principle of the 
pomegranate bark, by far the best taenifuge we 
possess. That of French manufacture is best, and 
the dose is all of the one gramme as put up in the 
bottle, repeated if necessary. His success is due in 
part to his plan of treatment, which is the following, 
given to a woman who had been passing tapeworm 
segments for eighteen years : At night, after twenty- 



THEKMIC FEVER. 289 

four hours of almost absolute fasting, five grains of 
calomel are to be taken ; on the following morning, 
one-half of the bottle of Tanret's solution of pelle- 
tierine, on an empty stomach, and two hours later the 
remainder of the solution. If free purgation does 
not soon follow, let the patient take pulvis jalapae 
comp. 5j. Prof. Da Costa repeats the treatment 
after the lapse of a week, and frequently a second 
worm is expelled, and sometimes three from one 
patient. 



In a case of tapeworm, at the clinic, Prof. Bar- 
tholow prescribed chloroform in 5ss doses, to be 
followed by a dose of castor oil. For one day pre- 
vious the patient had taken milk only as nourish- 
ment. 



TETANUS. 

Prof. Bartholow says physostigma must be pushed 
to the border line of danger in tetanus. Physos- 
tigmine (eserine) should be used hypodermically. 
He also considers bromide of potassium an important 
remedy in tetanus. The dose must be sufficient — 
one to two drachms every two, three or four hours. 



THERMIC FEVER. See Sunstroke. 

19 



290 THE PRESENT TREATMENT OF DISEASE. 

THROAT AFFECTIONS. See also Tonsillitis, Diphtheria, 
etc. 

Dr. Jurist recommends the following in various 

conditions of the throat requiring a gargle : — 

Tinct. guaiac. comp., 

Tinct. cinchon. comp., aa f5ij 

Potas. chlor., 5j 

Mel. desp., gj 

Aquae, . q.s. ad fgiij. M. 

Sig. — As a gargle. 



TONSILLITIS. 

In a clinical case of severe acute tonsillitis, Prof. 
Da Costa called attention to the success of the fol- 
lowing treatment : He gave ten grains of quinine 
daily, at first in a single morning dose ; afterward in 
divided doses. He allowed the patient to suck ice 
freely, and also applied the ice in bags to the outside 
of the throat assiduously. This was carried out 
very effectually ; for in place of the profuse suppura- 
tion which usually takes place in such cases in the 
tonsils, it was only superficial and very slight, and 
affected only one tonsil. Otherwise nothing locally 
was done ; he used a little water as a gargle, but 
no astringents, relying solely upon the ice which 
he sucked, and had applied to the angles of the 
jaw. 



TORTICOLLIS. 291 

TORTICOLLIS. 

Prof. Bartholow, in prescribing for a clinical case, 
said : All kinds of remedies have been used in 
vain, but we can do much in these cases by atten- 
tion to little details, and can cure the disease if it 
has not lasted too long. The best procedure is to 
galvanize the overacting and faradize the under- 
acting muscles. He would use fifteen cells of a 
small battery, applying the steady, non-interrupted 
current on the contracted muscles, and the inter- 
rupted current on the paretic muscles. He preferred 
the slow interrupted current, for the rapid interrup- 
tions will throw the muscles into a tetanic condition ; 
the slow current should be applied to each muscle in 
turn, and must be used regularly and perseveringly 
every day. 

A great deal can also be accomplished by gym- 
nastic training under the direction of the will, which 
should be used to educate the weaker muscles to 
antagonize the stronger. It is wonderful how much 
can be accomplished in this direction by the force of 
the will. All drugs that have a reputation for con- 
trolling muscular spasm have been tried in this 
affection, and hyoscyamus and gelseminum have 
done some good, but they do not cure. Arsenic 
thrown directly into the muscle, by hypodermic 



292 THE PRESENT TREATMENT OF DISEASE. 

injection, has done more good than anything else ; 
its use was begun empirically, because it was known 
to do good in chorea, which is a disease somewhat 
analogous to torticollis ; some very obstinate cases 
have been thus cured by arsenic. Cocaine, the drug 
of the day, has also been used with advantage, in- 
jections of one-sixth or one-fourth of a grain being 
made. While these injections are being made into 
the contracted muscles, strychnia should be similarly 
used in the paretic muscles. By these combinations 
we can generally cure the disease, if there be no 
lesion of the nerve, but we will find it a very 
obstinate disease to handle. 



Prof. Da Costa relieved a boy, at the clinic, almost 
entirely, of a severe torticollis, in five minutes, by 
having injected over the sterno-cleido-mastoid, atro- 
pine, gr. tutt, combined with morphine, gr. i. 



TUBERCULOSIS OF THE LUNGS. See Consumption. 



TYPHOID FEVER. 

Prof. Da Costa, in his lecture on this subject, gives 
the following directions for the treatment of typhoid 
fever : — 

1. Hygienic. — Place the patient in a large well- 



TYPHOID FEVER. 293 

ventilated room, so that he may get plenty of fresh 
air. Allow but one person (nurse) with him. Keep 
friends away. Enjoin cleanliness. Keep patient 
washed twice daily with vinegar and water, or a 
solution of permanganate of potassium. Disinfect 
the dejections with carbolic acid or chloride of zinc, 
etc. 

Nourishment. — There are times when the patient 
is weakest, as in the early morning ; this is the case 
in all low fevers. Nourish him every two hours 
with beef or mutton broths, alternating with milk. 
Other broths, as chicken, etc., may be used. If the 
patient craves for more solid food, allow him at the 
mid-day meal a little arrow-root boiled in milk, or a 
soft-boiled egg. Excepting these, allow no form of 
solid aliment until convalescence is completely estab- 
lished, and even then be careful. Be sure to feed 
the patient between 4 a. m. and 5 a. m. ; even wake 
him at this time to feed him. Allow a liberal sup- 
ply of water, or toast- water, ginger syrup and water, 
or claret and water. It will keep the kidneys washed 
out. 

2. Medical Treatment. — Different plans have 
been instituted : — 

1. Quinine, which has been justly abandoned. 

2. The mercurial plan — calomel, grs. v-x per 



294 THE PEESENT TREATMENT OF DISEASE. 

diem, at the first stage of fever — said to modify 
the intensity of the fever process. Not an effective 
plan. 

3. Carbolic acid, gtt. j-ij, in mint water, every two 
hours. This remedy is not to be relied upon. 

4. Iodine treatment, as Lugol's solution, gtt. ij, 
four times a day. This promises something good in 
the way of treatment. 

5. The plan used by Dr. Bartholow in the follow- 
ing combination : — 

Acid, carbolic, f5j 

Tinct. iodinii, f5ij. 

Dose, gtt. j-iij, every two or three hours. 

This is a good plan of treatment. 

6. Prof. Da Costa's plan is by the use of mineral 
acids. Those that use this plan in Germany prefer 
sulphuric acid ; in England, hydrochloric ; in France, 
phosphoric, and in America, nitro-hydrochloric acids. 
Of the last, an ordinary prescription is gtt. xx of the 
dilute acid in simple elixir. This will also control, 
to some extent, the diarrhoea. 

Do nothing else if you can possibly get along 
without, but guard against complications, and treat 
them immediately as they arise. 

The first prominent symptom to be noticed is the 



TYPHOID FEVER. 295 

diarrhoea. If there are but three stools, unless they 
be unusually large, do nothing. If very profuse, 
give a little tinct. opii camphorata at night, or 
an opium suppository, gr. j. Should this fail, 
use — 

Bismuthi subnitrat, gr.x-xx 

Opii, gr.ss-j. 

Sig. — Every three hours. 

If this fails, try carbolic acid, gtt. j, with morphinse 
sulph., every three hours. Often cupri sulph., gr. tV, 
with opium, gr. 3, is very effective. 

For the tympany, cold applications, or injections 
of vinegar, foj-ij to water Oj. Internally administer 
turpentine, gtt. vij, in emulsion, with morphia, gr. ts. 
Often strychnia is useful, but secondary to the above. 

Thoracic symptoms. — The pulmonary congestion 
occasions cough ; the patient's position must there- 
fore be changed frequently. If the patient is not too 
feeble, use dry cups. The internal use of turpentine 
is of avail when marked fever is associated with the 
congestion. Do not give expectorants. If there is 
a large accumulation of mucus, use aromatic spirits 
of ammonia. 

Sustain the circulation by quinine in tonic doses, 
gr. vj-x, in the twenty-four hours, but alcohol is the 



296 THE PEESENT TEEATMENT OF DISEASE. 

best, repeated in small doses, to keep up the heart's 
action. In the early morning increase the dose. 
Under stimulus the pulse of one hundred and fifty 
should come down to one hundred and twenty or one 
hundred and ten. The first sound of the heart is 
the key to the amount required. From four to ten 
ounces of brandy or whiskey may be necessary. For 
nervous symptoms, as headache, delirium, etc., give 
opium with camphor, or with belladonna. Chloral 
is the most useful, but do not give it when the heart 
is weak. 

For high fever, cold water is excellent. Put the 
patient in a bath until the temperature of the water 
gets to 72° F. The tendency to intestinal hemorrhage 
is greater in this treatment than by quinine, which is 
next in importance, and should be given in doses of 
gr. xx-xxx in the day. 

For intestinal hemorrhage, ergotin, gr. ij-vij, hypo- 
dermically, or f3j fluid extract of ergot may be 
given every hour or two. Sulphuric acid is also 
useful. Opium, to keep the bowels at rest, is indis- 
pensable. Cut down milk and stimulus now. 

Spreading tenderness (peritonitis). Tinct. opii 
deodorat., gtt. x every hour, and gr. j opium supposi- 
tory at the same time. The suppository must not be 
repeated for four hours. 



TYPHOID FEVER. 297 

Should the patient have parotiditis ice is the best 
treatment; also tinct. ferri chloridi, to enrich the 
blood. 

For the functional palsies use strychnia. 



Dr. Howard J. Williams, of Macon, Ga., recently 
read a paper before the Georgia Medical Association, 
in which he thus describes the treatment of typhoid 
fever followed at Jefferson Medical College Hospital 
when he was a resident there : — 

The patient, of course, was attended by trained 
nurses. For convenience, cleanliness, and to avoid 
unnecessarily disturbing the patient while having a 
passage, he was placed on a fracture-bed, with the 
pan constantly in place. Milk and beef tea, or beef 
extract, constituted the diet. One-half pint of each 
was given systematically, alternately, every two 
hours. Medicinally one gtt. of a ninety-five per 
cent, solution of carbolic acid, and two drops of the 
compound solution of iodine, were combined at the 
bedside and administered every four hours. If the 
case required stimulants, whiskey or brandy, or car- 
bonate of ammonium, was administered every two 
hours. When the fever was very high and required 
reduction, quinine and general sponging were em- 
ployed. For delirium, opium alone or opium and 



298 THE PRESENT TREATMENT OF DISEASE. 

bromide of potassium were used. And so all promi- 
nent symptoms were combated as they arose, and 
when they had departed the extra medication was 
discontinued. 



Dr. Joseph Neff, of the Jefferson Medical College 
Hospital, thinks quinine is a more reliable antipyretic 
than antipyrin in typhoid fever, but he uses the latter 
as a temporary measure in very high temperature, 
and the quinine to keep the temperature down when 
reduced. He does not give stimulus during the first 
week or two, and the amount then is limited by 
the effect produced only. In two cases he gave as 
high as thirty-six ounces in twenty-four hours, with 
good results. As a disinfectant for the excreta he 
uses — 

9. 

Thymolin., * Oj 

Hydra rg. chlorid. corrosiv., g r «^ v j 

Aquae, Oviij. M. 

Sig. — About a half a pint to be applied to each stool. 

Cardinal rules of his, in the treatment of enteric 
fever, are : Always visit the patient twice per day ; 
always take the temperature at every visit; always 
percuss the bladder and listen to the lungs at every 
visit. He uses the carbolic acid and iodine treat- 
ment. 



TYPHOID FEVER. 299 

In a clinical case of typhoid fever, accompanied 
with marked hyperpyrexia, persisting in spite of 
appropriate medication,* Prof. Da Costa called atten- 
tion to the fact that his general condition had im- 
proved under the following treatment : Dilute muri- 
atic acid (gtt. v) and turpentine (gtt. x) every two 
hours. He also took twelve grains of quinine daily, 
and six ounces of wine and six of whiskey. His 
food consisted of milk and beef tea, two pints of 
each in the twenty-four hours. 

When he found that the man had, a week ago, an 
evening temperature remaining persistently at 104°, 
he tried to reduce it by large doses of quinine, six- 
teen grains daily, and on one day he took ten grains 
morning and evening. He was also frequently 
sponged with cold water. The effect was but slight ; 
the temperature remained high. 

Prof. Da Costa then directed that cloths wrung 
out of ice water should be laid upon the abdomen 
until the desired result was obtained. The tempera- 
ture was at once reduced to 100°, so that by this 
means he was enabled to keep the temperature within 
bounds, and thus to gain time. He discussed the 
expediency of putting him in a bath, but, as he was 
very weak, and the bath-room was some distance from 

* Medical Times. 



300 THE PRESENT TREATMENT OF DISEASE. 

his bed, rather than subject him to the risks of so 
much handling, he yielded the point, though, if the 
bath had been more convenient, he would have pre- 
ferred it. He wished to call attention especially to 
the use of ice- water applications to reduce tempera- 
ture, as a substitute for the large doses of quinine 
and cold baths, which are not always convenient. 

This was a most instructive case. Indeed, he con- 
sidered that the man's life had been saved by this 
means. Taking into consideration the rising tem- 
perature and the falling circulation, as shown by the 
impaired heart sounds, it did seem likely that the 
case would not get well. He would also call atten- 
tion to the fact that in this case the quinine failed 
to reduce the temperature. It does not often fail, but 
it did here. 



Prof. Da Costa has found thymol to be as effective 
as, and less disagreeable than, carbolic acid, as an 
antipyretic in typhoid fever. The dose is one- half 
to two grains, preferably in solution. 

He had, at the Pennsylvania Hospital, a rare 
sequel of typhoid fever — perityphlitis. He directed 
that it be treated with poultices, opium, quinine, and 
supporting measures ; the aspirator to be used if any 
evidence of pus appeared. 



VAGINITIS. 301 

ULCERS. 

To the granulating surface of an ulcer, Prof. 
Gross applies the following: — 

Acidi nitrici, 5j 

Pulv. acac, §ss 

Aquae, Oj. 

Or— 

]*. 

Ung. hydrarg. nitrat., 5j 

Adipis beozoat., 5x. M. 

These are used to promote rapid cicatrization. 



For chronic ulcers of the leg which resist various 
plans of treatment, Prof. Bartholow advises that the 
surface and surrounding skin be blistered, to be fol- 
lowed by the application of a poultice. This done, 
use the following : — 

Plumbi nitrat., 5j 

Ung. petrolei (cosmoline), Sj. M. 



VAGINISMUS. See Genito-Urinary Organs (Female), Dis- 
eases of. 



VAGINITIS. See Genito-Urinary Organs (Female), Diseases 
of. 



302 THE PRESENT TREATMENT OF DISEASE. 

VERTIGO. 

For gastric vertigo, with disturbed circulation, 
Prof. Da Costa administered, in the case of a man — 

Argenti oxidi, gr.ss 

Ext. hyoscyarni, gr.ij. M. 

Sig. — Ter die. 

He also prescribed pepsin at meals. 

In another case, with beginning cirrhosis of the 
liver, he directed that the phosphate of sodium, 5j, 
be taken every morning ; and hydrarg. chlorid. cor- 
rosiv., gr. A, ter die, to keep up the secretion and to 
act on the liver. The patient must live on a diet of 
meat, milk and vegetables, taking no oleaginous food 
whatever. 

Cases of stomachal vertigo, where the attack hap- 
pens in the night or early morning, Prof. Da Costa 
often treats successfully by having the patient take a 
late supper of some easily digested food. 

In a clinical case of gastric vertigo, Prof. Bar- 
tholow prescribed, with good results, hypodermatic 
injections of strychnia, and remedies to improve the 
digestion. He had seen the greatest improvement in 
these cases from Fowler's solution, two drops given 
just before each meal ; it is of the greatest service 
in stomachal vertigo. 



VOMITING OF PREGNANCY. 303 

In a case of labyrinthine vertigo, associated with 
impairment of hearing, Prof. Bartholow called 
attention to the great benefits to be derived from 
quinine in these cases. We have several remedies, 
all of which have somewhat the same action as 
quinine. We thus can use quinine, salicylic acid or 
salicin. All of these drugs, when used in large 
doses, produce more or less buzzing and vertigo. 
Quinine causes this buzzing, because it occasions a 
condition of anaemia of the parts, lessens congestion 
and so favors absorption. It must be given in large 
doses, not less than five grains thrice daily, and, if 
the patient will bear it, more good will be derived 
from ten-grain doses, continued for three days, then 
five-grain doses for the balance of a week, when its 
use should be suspended, to be resumed, if necessary. 
He would impress the fact of the importance of care- 
fully inspecting the ear. Remember that this is not 
truly Meniere's disease, though the name is sometimes 
applied to it. These cases are much milder, and the 
term should be strictly confined to those cases in 
which there are hemorrhage, unconsciousness and 
extreme vertigo. 



VOMITING OF PREGNANCY. See Pregnancy. 



304 THE PRESENT TREATMENT OF DISEASE. 

WHOOPING COUGH. 

To cut short the paroxysm in whooping cough, 
Prof. Da Costa recommends the inhalation, by means 
of an atomizer, of — 

Sodii brornid., gr.xx 

Ext. belladonnae fluidi, gtt.ij 

Aquae, fgj. M. 

Sig. — The spray to be inhaled just prior to occurrence 
of the paroxysm. 

In the interval, quinine should be pushed up to 
the point of tolerance. 



The nervous cough of mothers, which exists during 
the presence of whooping cough in the household, 
may be allayed, according to Prof. Bartholow, by — 

Acid, hydrocyan. dil., f5j 

Tinct. sanguinariae, f3iv 

Syr. senegse, fSss 

Syr. tolu, fSij 

Aquam lauro-cerasi ad f§iv. M. 

Sig. — f5j-ij every three or four hours. 



INDEX. 



Albuminuria, 9, 26 
Alcoholic hallucinations, 9 
Alcoholism, 9 
Alopecia, 10 
Amenorrhcea, 11 
Anaemia, 14, 212 

pernicious, 16 
Aneurism, 17 
Angina pectoris, 18 
Aphthous sore mouth, 19 
Apoplexy, 20, 228 
Argyria, 20 
Arteritis, 21, 113 
Arthritis, rheumatoid, 257 
Asthenia, 21 
Asthma, 22, 24 
Atheroma, 24 

Bladder, affections of, 25, 145 
Blepharitis, 133 
Boulimia, 25 
Bright' s disease, 26 
Bronchial asthma, 34 

catarrh, 34 
Bronchitis, 34 
Burns, 36 

Calculus, 36, 204 
Cancer, 36 

gastric, 37 

hepatic, 37 

omental, 37 

uterine, 37 
Carcinoma, 36 
20 



Catarrh, bronchial, 34 

gastric, 138 

gastro-intestinal, 143 

nasal, 39 

post-nasal, 39 

renal, 147 
Catarrhal fever, 42 
Cerebral embolism, 43 

hyperaemia, 43 
Cerebro- spinal fever, 43 
Chancroid, 44 
Chilblains, 45 
Chlorosis, 45 
Cholera, 46 
Chorea, 49 

Cirrhosis of the liver, 54, 181, 205 
Colds, 54, 70 
Colic, 54 

Conjunctivitis, 133 
Constipation, 57, 202 
Consumption, 63 
Cory.aa, 70 

Croup, spasmodic, 75, 199 
Cystitis, 75, 145 

Dactylitis syphilitica, 285 
Delirium tremens, 75 
Diabetes, 75 
Diarrhoea, 81 

Dilatation of the stomach, 277 
Diphtheria, 88 
Dysentery, 100 
Dysmenorrhcea, 102 
Dyspepsia, 102 

305 



306 



INDEX. 



Eczema, 266 
Emphysema, 111 
Endarteritis, 113 
Endocarditis, 114, 251 
Enteritis, membranous, 115 
Entero-colitis, 116, 191 
Epididymitis, 116 
Epilepsy, 117 
Epistaxis, 121, 179 
Epithelioma, 121 
Erysipelas, 122 
Erythema nodosum, 267 
Exophthalmic goitre, 128, 152 
Eye, diseases of, 133 

Favus, 268 
Fibroid, uterine, 148 
Floating kidney, 135 

Gastralgia, 137 
Gastric cancer, 37 

catarrh, 138 

ulcer, 140 
Gastritis, 138 

Gastro-intestinal catarrh, 143 
Genito-urinary affections, 145 

organs (female), affections of, 
148 
Goitre, 151 

exophthalmic, 128, 152 
Gonorrhoea, 153 
Gonorrhceal rheumatism, 258 
Gout, 159 
Gumma, 281 

Hsematuria, 159 
Haemoptysis, 160 
Hay fever, 160 
Headache, 161 
Heart, affections of, 163 
Heat exhaustion, 277 



Hectic fever, 177 
Hemicrania, 161, 177 
Hemiplegia, 177, 228 
Hemorrhage, 177 

pulmonary, 160, 178 

renal, 159 

uterine, 180 
Hepatitis, 181 
Herpes annularis, 268 

zoster, 185 
Hodgkin's disease, 186, 206 
Hypochondriasis, 186 

sexual, 187 
Hysteria, 188 
Hystero- epilepsy, 188 

Ichthyosis, 269 
Ueo-colitis, 191 
Impotence, 192 
Incontinence of urine, 193 
Indigestion, 102, 194 
Inflammation, 194 
Influenza, 70, 160, 195 
Intermittent fever, 195, 209 
Intestines, diseases of, 81, 100, 116, 

143, 191, 195 
Iritis, syphilitic, 286 
Itching of the skin, 269 

Jaundice, 195 

Kidney, contracted, 29 

floating, 135 
Kidneys, diseases of, 26, 145, 148, 

199 
Koumiss, 138 

Laryngismus stridulus, 199 
Lead poisoning, 200 
Leucorrhcea, 203 
Lithaemia, 204 



INDEX. 



so: 



Liver, cancer of 37, 205 

cirrhosis of 54, 181, 205 
inflammation of, 181, 205 

Locomotor ataxia, 205 

Lumbago, 206 

Lymphadenoma, 206 

Lymphatic glands, obstruction of, 
208 

Malarial diseases, 209 
Measles, 219 
Meningitis, 219 
Menorrhagia, 180, 220 
Metrorrhagia, 180, 220 
Migraine, 161, 220 
Mucous patches, 287 
Myalgia, 220 

Nasal catarrh, 223 
Nephritis, 26, 223 
Neuralgia, 223 

uterine, 225 
Night terrors, 117, 225 
Nymphomania, 226 

Obesity, 226 
(Edema, 227 
Ophthalmia, 134 

Paralysis, 228 

Paraplegia, 234 

Parasitic skin diseases, 269 

Parturition, accidents and affections 

of, 242 
Perityphlitis, 300 
Phthisis, 63 . 
Pleurisy, 235 
Pneumonia, 237 
Post- nasal catarrh, 223 
Pregnancy, affections and accidents 

of, 242 



Pregnancy, hygienic management 

of, 246 
Progressive muscular atrophy, 247 
Pruritus, 270 

ani, 270 

pudendi, 148 

vulvae, 270 
Psoriasis, 270 
Purpura, 272 

Renal calculus, 204 

inadequacy, 147 
Rheumatism, 249 

gonorrhceal, 157 
Rhinitis, 258 
Rose cold, 160, 258 

Saint Vitus' dance, 258 

Scarlet fever, 258 

Sciatica, 259 

Sclerosis, posterior spinal, 260 

Scurvy, 265 

Sea sickness, 266 

Skin diseases, 266 

parasitic, 269 
Small pox, 272 
Spermatorrhoea, 273 
Spinal sclerosis, posterior, 260 
Sprains, 275 

Stomach, diseases of, 276 
Stye, 134 
Sunstroke, 277 
Surgical fever, 278 
Syphilides, 285 
Syphilis, 279 

cerebral, 282 

congenital, 280 

secondary, 283 

tertiary, 285 

Taenia, 288 
Tapeworm, 288 



308 



INDEX. 



Tetanus, 239 
Thermic fever, 2S9 
Throat affections, 290 
Tonsillitis, 290 
Torticollis, 291 
Tuberculosis, 63, 292 
Typhoid fever, 292 

Ulcer, gastric, 140 

Ulcers, 301 

Uric acid calculus, 205 

Urine, incontinence of, 193 

Urethra, morbid sensibility of, 146 

Uterine fibroid, 148 



Uterine neuralgia, 225 
Uterus, applications to, 149 

Vagina, wash for. 148 
Vaginismus, 148 
Vaginitis, 149 

Varicose veins of vulva, 148 
Vertigo, gastric, 302 
labyrinthine, 303 
Vomiting of pregnancy, 244 
Vulva, varicose veins of, 148 

Whooping cough, 304 



